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GSF developed from ‘the bedside not the boardroom’; refined by clinicians rooted in practice in each setting to ensure programmes are transferable, effective and sustainable in practice.

Origins & Spread of GSF

The Gold Standards Framework and the work of The National GSF Centre in End of Life Care was first developed in England back in 2000 by Prof Keri Thomas, working then as a GP and Palliative Care Doctor in a hospice. 


Working with other interested GPs and Palliative Care specialists, they wanted to discuss what ‘a gold standard of care‘ for people nearing the end of life would look like, and then develop a practical step-by-step framework to get there.


The early pilots in 12 GP practices were successful, and strongly affirmed the importance of providing top quality care for people nearing the end of life, serving as a real aspiration for many that sometimes felt unable to achieve.


This was recognised nationally as an example of best practice by the Department of Health, then from 2004 was mainstreamed in NHS policy and grew nationally across the UK, until every GP Practice was using basic level of GSF (Bronze level) by 2010. 


The Care Homes programme was developed in 2004, followed by the Hospital programme in 2008 and subsequently grew to 12 GSF programmes across all sectors, each based on the same underlying principles and framework, tailored for each setting.

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1   1999-2002 Early days

  • GP in Yorkshire with NHS support  and  NHS funded pilot (Macmillan part funded)

 2003- 2010  -NHS

  • Quality improvement model

  • GSF mainstreamed to every UK GP practice  QOF 2004

  • KT -DH National Clinical Lead Palliative Care

  • NHS EOLC Strategy+ Programme - DH funded 

  • 3 GSF programmes

  • GPs care homes , hospitals 

3  2010-2020 –GSF Centre CIC

  • Not-for-profit vol sector CIC  Social enterprise from NHS

  • Self-sufficient ,no fundraised

  • Grew to 12 programmes in the UK  and 18 Regional Training centres ​

4 2020 onwards 

  • GSF UK continues through The GSF Centre CIC  , working in association with Hospice UK and other organisations . 

  • GSF International continues separately for charitable work in Africa through The Andrew Rodger Trust and other non-UK work through Horizon 


Within healthcare, there was a gradual shift from a focus on Cancer patients towards the inclusion of a wider range of conditions such as organ failure, frailty, dementia and multi-morbidities. This was greatly enhanced by the recognition of Frailty as a condition and the use of the Electronic Frailty Index. 


With the UK's Quality Outcomes Framework (QOF),  changes in the GP's Contract in 2004, improving care for all people irrespective of diagnosis was recognised.


The BMA then asked Keri at University of Birmingham to develop the PIG guidance to help GPs identify which patients with non-cancer need to be included on the GSF Registers. This was formerly known as the GSF Prognostic Indicator Guidance but since 2016 known as the Proactive Identification Guidance  , and to enable more proactive care for all people nearing the end of life.

For more on the PIG Tool, click here

After 20 years we estimate we have trained over 20,000 staff in over 3,500 teams, and affect the care of at least half a million people every year.  

Spread of GSF 

Since then GSF has spread across the UK  to be used at basic level by every GP practice, thousands of care homes, hospitals and other care providers, affecting the care of many millions of people.



GSF Training programmes to all settings


12 GSF programmes across all settings of health and social care including; Primary Care GSF (2000), Care Homes (2004), Acute and Community Hospitals (2008), Domiciliary Care (2012), hospices, prisons, retirement villages and other settings with support programmes including Spiritual Care, Dementia care and Clinical Skills. 18 current GSF Regional Training Centres  in the UK providing some GSF training 



GSF accreditation


8 Accreditation processes with the GSF Quality Hallmark Awards co-badged by national organisations and recognised by CQC, with some care homes now returning for 4th time accreditation 12 years on.



Integrated care 


10 Cross Boundary care Sites, demonstrating how GSF can help- change the vocabulary in an area, leading to more integrated care.

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GSF Primary Care

All 8500 GP practices doing basic bronze

Over 700  doing  silver/ gold   


GSF Care Homes

3200 trained – 25% N homes

GSF Acute Hospitals

477 wards in 49 hospitals

GSF Community Hospitals

62 wards in 50 hospitals

GSF Domiciliary Care

Almost 2000 care workers

GSF Hospice Support

8 hospices – 3 accredited

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GSF Prisons

3 prisons  

GSF Retirement Village

29  RVs

GSF Integrated Cross Boundary Care

Sites – 10 sites

Plus Online Programmes in;

Dementia Care

Clinical Skills

Spiritual Care/Compassion

Mainstreaming in Policy 

The principles of GSF have influenced national policy and helped implement key initiatives, becoming mainstreamed to improve end of life care across the whole country.

  • QOF 2004 all GP practices

  • NHS EOLC Strategy

  • NICE Guidance

  • CQC assessments – hospitals

  • Social Care sector

  • Ambitions

  • 2019 Long Term Plan

Sect 1.42 proactive personalised coordinated care 

  • QOF GP Contract- QOF QI GP practice teams, 2020

  • Enhanced Health in Care Homes EHCH , DES

  • NHS England Personalised  Care Policy

  • NICE Guidance in EOLC  2011 and 2021

  • NICE Guidance in EOLC Service Delivery 2019  

  • National EOLC Intelligence  Network

  • See other examples of mainstreaming GSF and its principles in 

    • Proactive early identification here,  

    • Advance Care Planning here 

    • in better coordination here 

    • and more on the evidence section here 

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NICE Guidelines End of Life Care

Service Delivery  2019 See here

 1.1 Identifying adults who may be approaching the end of their life, their carers and other people important to them

1.1.1 .. develop systems to identify adults who are likely to be approaching the end of their life (for example, using tools such as the Gold Standards Framework, Amber, SPICT). .. to start discussions about advance care planning,  provide the care needed, and to support people's preferences for where they would like to be cared for and die.

‘By rolling out training to help staff identify and support relevant patients, we will introduce proactive and personalised care planning for everyone identified as being in their last year of life.’

NHS Long Term Plan 2019 Sect 1.42

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Further Reading

How GSF supports National UK Policy Implementation click here

How GSF helps face the reality of death. Dying Matters Blog April 2015  click here

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