‘Now nobody falls through the net’: practitioners’ perspectives on the Gold Standards Framework for community palliative care

Abstract

The Gold Standards Framework (GSF) seeks to facilitate consistent and high quality community palliative care through a set of guidelines, mechanisms and assessment tools. The present study set out to examine practitioners' perspectives on the GSF during its first national roll-out. Two general practices that had adopted the GSF were recruited in each of four geographical areas, and each matched as closely as possible with a non-GSF practice. Sixty-eight semi-structured telephone interviews were carried out with general practitioners and district nurses in 16 selected practices, along with the GSF facilitator and up to four other 'stakeholders' in each area. Analysis revealed that the majority of GSF participants felt that the framework had strengthened their provision of community palliative care. In particular, communication within primary health care teams and co-ordination of services improved, aspects which were better in the GSF practices than in the matched non-GSF practices. Practitioners felt there was more consistency of care, with a reduced likelihood that individual patients would 'slip through the net'. The most common areas of concern were in relation to the workload associated with the role of the GSF co-ordinator. Implications for the development and effective implementation of the framework and for further research are discussed.

Interprofessional relationships and communication in primary palliative care: impact of the Gold Standards Framework

“…This study confirms and builds on the finding of King,et al,12 who reported on a qualitative evaluation of a pilot phase of the framework involving 76 practices. They identified that in practices implementing the framework, communication was improved, processes strengthened, and terminally ill patients were less likely to be overlooked within the practice.…”

Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts

“…10,12 It may be that these were valued aspects of the GSF for nurses in particular because they facilitated practice changes in previously problematic areas and to GPs because they matched changes to their contract.…”

Palliative Care in the Community

“…10 However, variations in how the programme had been implemented; differences in levels of commitment among professionals within individual practices; and the increased administrative burden, particularly on the framework coordinator within the practice, were highlighted as drawbacks. 10 The extent to which these problems threaten the effectiveness of the programme in future practices remains to be seen.Despite a paucity of evidence linking structured approaches in primary palliative care with outcomes, patients and carers undoubtedly value a holistic approach with care planning, good communication, and continuity of care from primary care teams. 11 12 While some practice based audits suggest that adopting the framework may enable more patients to die at home, 7 it is still uncertain how widely this aim can be realised.…”

“…As a result, planning of care had improved and practitioners had more confidence in symptom control. 10 However, variations in how the programme had been implemented; differences in levels of commitment among professionals within individual practices; and the increased administrative burden, particularly on the framework coordinator within the practice, were highlighted as drawbacks. 10 The extent to which these problems threaten the effectiveness of the programme in future practices remains to be seen.…”