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.
1 1999-2002 Early days
GP in Yorkshire with NHS support and NHS funded pilot (Macmillan part funded)
2 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
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.
10 Cross Boundary care Sites, demonstrating how GSF can help- change the vocabulary in an area, leading to more integrated care.
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
GSF Retirement Village
GSF Integrated Cross Boundary Care
Sites – 10 sites
Plus Online Programmes in;
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
CQC assessments – hospitals
Social Care sector
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
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
How GSF supports National UK Policy Implementation click here
How GSF helps face the reality of death. Dying Matters Blog April 2015 click here