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“Screening utilising the Gold Standards Framework PIG guidance in the acute setting could be the first step towards implementing a more systematic way of addressing patient need - both current unrecognised and future anticipated - thereby improving outcomes for this population”  


O’Callaghan et al New Zealand 2014 

Background, development and regular revisions of PIG

Development of this guidance paper.


This guidance was originally commissioned from the GSF Team in 2004 to support GPs with inclusion of appropriate patients on their QOF Palliative Care Registers i.e. those considered to be in the final 12 months of life.


It is regularly revised following extensive consultation with specialist clinical and disease groups, palliative care specialists and GPs in the Royal College of General Practitioners. Particular thanks go to the NHS End of Life Care Programme and University of Edinburgh team for their help.

Since publication, this Guidance has been widely used by clinicians in many sectors in the UK and abroad. A list of detailed references is available. This is one of several tools available from The GSF Centre for End of Life Care and further details on best use, IT support and further developments can be obtained from the GSF Centre.

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Early identification is now mainstreamed in national policy and Guidance from NICE UK  (National institute for Health and Care Excellence)

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For the revision 2021, we are grateful to the PIG revision 2021 Expert Advisory Group who contributed to this guidance, including responses from;

  • The British Geriatric Society

  • British Thoracic Society

  • NHS England

  • Royal College of General Practitioners

  • Royal College of Physicians

  • Motor Neurone Disease Society

  • Parkinson’s Society

  • Dementia UK, and others. 

NICE Quality Standards for End of Life care

2011 revised 2017  see here 


Statement 1 

"People approaching the end of life are identified in a timely way."

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 People managing and delivering services should 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, the Amber Care Bundle or the Supportive and Palliative Care Indicators Tool [SPICT]). This will enable health and social care practitioners 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.

1.1.2 Health and social care practitioners should identify carers and other people important to adults who are likely to be approaching the end of their life.

References, Resources and Further Reading:


For Frailty EFI

For Dementia- Dementia UK and see NICE Dementia Guidance 2018

For Stroke

National Primary Care Snapshot Audit (2009/2010) DH report
NHS End of life care programme

NHS Department of Health. End of Life Care Strategy (2008) P51, 3.22


GMC End of Life Care


National Audit Office report Nov 08.

British Geriatrics Society


The ‘Surprise question’.  Living Long in Fragile Health: Lynn J, 2005

Dying Matters- Find the 1% campaign

Frameworks for Implementation (2010) from the End of Life Care Programmes -

Renal advisory group of the NSF, British Renal Society, and British Transplant Society.

Barthel Score:  Barthel's index of activities of daily living (BAI)


Glare P (2011). Predicting and communicating prognosis in palliative care.



Glare P, Sinclair CT (2008). Palliative medicine review: prognostication.

J Palliat Med;11;84-103


Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L (2011) Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study.



McDaid P (2011) Quick Guide to Identifying Patients, Islington PCT, (personal communication)

Quinn TJ, McArthur K, Ellis G, Stott DJ (2011). Functional assessment in older people.

BMJ ;343:d4681


Quinn TJ, Langhorne P, Stott DJ (2011). Barthel index for stroke trials: development, properties and application.

Stroke; 42:1146-51


SPICT Guidance University of Edinburgh (2010). Supportive and Palliative Care Indicators tool (SPCIT)

SPOTLIGHT: Palliative care beyond cancer: Recognising and managing key transitions in end of life care: Boyd K, Murray S BMJ 341

Watson M, Lucas C, Hoy A, Back I (2005) Oxford Handbook of Palliative Care. Oxford University Press

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