“To think about patients as a whole...
...a whole geography level"
Julie Barker GP in Newark & Macmillan GP Nottingham ICS
GSF in Primary Care
Background
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Gold Standards Framework (GSF) in primary care was the first GSF programme developed back in the early 2000s by primary care for primary care.
It’s aim was to enable GPs (family doctors) and primary care teams to provide care that is more proactive, personalised to patients' needs and wishes, for all people in their final year of life, with any condition, in any setting, at any time.
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The basic GSF ‘bronze’ level principles were first piloted in 2000, then mainstreamed to all GP practices in the UK as part of the GP Contract (QOF) from 2004.
GSF principles became integrated within national policy (Government Dept of Health, NICE guidance, Royal College of GPs, regulators, NHSE Long term Plan etc) and actively encouraged and spread to every GP practice.
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Mainstream GSF to every UK GP practice
One of the greatest successes of GSF was that it became mainstreamed within primary care, as the ‘bedrock of community palliative care’. This enabled great support for a wider number of patients, not just those with cancer who were best known to the specialist palliative care and hospice teams, and helped integrate all those with 'non-cancer' conditions - over 75% of all patient deaths .
With recognition of the ageing population, the increase of frailty and quantifying of this with the GPs’ Electronic Frailty Index, more people were recognised early and offered more proactive supportive care including more being able to live and die at home, if they so choose.
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The UK is the only country in the world to have spread this work nationwide and use of GSF has helped many thousands of staff and many millions of patients receive better care.
GSF Primary Care in a Nutshell
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Now in the UK, every GP practice has a register and team meeting, as first promoted by GSF
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They are is encouraged to proactively identify earlier those who may be in the last year/s of life
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and include them on a register (about 1% of the population on these GSF/supportive /palliative care registers)
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personalise care aligned to wishes of patients through offering advance care planning discussions
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hold regular proactive meetings to discuss
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and coordinate their care.
The 3 GSF pillars as in the GSF summary are
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to identify people earlier (proactive care)
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assess (personalise)
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and plan (coordinate ) care,
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to enable improved
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quality of care,
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teamwork
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and better outcomes for patients
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and for health system-
to promote more proactive person-centered systematic care.
Now with greater geographical areas covered and a focus on integration across health and social care, GSF is part of the move to population-based end of life care across the UK.
See BJGP Editorial Population-based End of Life care Article here
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Since then, further GSF Silver and Gold programmes were developed and extension to all other settings ie nursing / care homes, hospitals and other care providers.
GSF Primary Care Summary
See short video ,BMJ article and other examples of excellence below-
EAPC talk- GSF Covid and Beyond
Narrated talk for EAPC Primary palliative care Group
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GSF Medley of Experiences in Primary Care
Introduction to Primary Care
GSF Works! Examples in Primary Care
Some words from our colleagues in the UK:
“The GSF programme has helped us change the culture of the practice. Now, with better planning, communication and coordination, we have increased the number of people dying in their preferred place and significantly improved the support we provide their carers.
The GSF programme has helped us change the culture of the practice. Now, with better planning, communication and coordination, we have increased the number of people dying in their preferred place and significantly improved the support we provide their carers.”
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Ian Livingstone, GP Lead,
GSF Accredited practice
“GSF has been transformational for us as a practice and for our patients."
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Au GP
GSF Accredited practice,North West
”GSF has helped us to provide end of life care for a much wider patient group and reduced our hospital admissions - we're providing better quality, cost-effective care, enabling more patients to die in their preferred place.”
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Dr Helena Rolfe
Ilkley Moor Medical Practice, West Yorkshire
”GSF has really helped us to have a good structure in place and given everyone in the practice the confidence to initiate what can be difficult conversations with people about where and how they want to be cared for and that means everyone feels more in control.”
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Dr Sally Giovanelli
GSF 2nd time Accredited practice, Derbyshire
“GSF presents the vision but also the practical tools and resources to make it happen. Doing ‘GSF Going for Gold’ with our practices has been transformational - it really works. It's the difference between the Premier League and League Division Three”
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Dr Peter Nightingale
GP Lead, Former RCGP End of Life Care Lead
"The college is pleased to support GSF as a major component of the RCGP End of Life Care Strategy. End of life care is part of the core business of general practice and GSF provides a standard against which we can measure our practice and means to further improve it."
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Professor Nigel Mathers
RCGP
International Examples from Beyond the UK
Amsterdam Netherlands
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Since 2013 there has been a detailed project involving GPs in Amsterdam using GSF in Primary Care to develop registers, MDT meetings and offer advance care planning and to embed this within the system
Vancouver BC, Canada
Since 2011 there has been much interest in using GSF principles and approach within Family Doctor teams to improve early identification of GSF patients , including in a register and offering of advance care planning conversations, led by Dr Doris Barwich.
Australia
Since 2011 ,there have been GSF projects in many areas of Australia ,adapting some of the GSF principles and tools within Primary Care eg Geelong Family Doctors Practice , Brisbane, Sydney, Newcastle etc . We have been working mainly with the Australian Palliative Care Association and GP Associations and Leaders such as Prof Geoff Michell from Brisbane University