Sharon Cansdale
GSF
Facilitator

• Multiple co-morbidities.
• Increasing memory loss/dementia.
• Difficulty predicting prognosis
• Difficulty predicting dying phase
• Complex social/health factors
• Need protection from over intervention; trolley deaths, DNAR.

• Half a million people live in care homes-about
1% of the population.
• Approx 20% people die in care homes
86% all deaths over 60 - 51% in people over 80
• For every NHS bed there are 3 care home beds
• The sector employs about 1.2 million people
• Education alone in care homes does not work – needs change management skills to embed new system plus supported learning (Froggatt et al)

• Crises out of hours
• Residents being sent into hospital without a visit. 999
• Drugs and equipment availability
• Residents/family expectation
• Access to education and training
• Clarity of what CH can offer
• Lack of confidence

July 08
‘
Inadequate training of staff at all levels within care homes, sheltered housing and extra care housing sector…is considered to be the single most important factor
’
• Factors leading to suboptimal care;
• Lack of ACP
•
Inadequate recognition and holistic assessment
• Death Concerns
•
Impact on other residents
• Inadequate access to NHS services
•
Inadequate medicine reviews
• Training

The GSF Care Homes
Training Programme
Goals
1. To improve the quality of end of life care
2. To improve collaboration with primary care and palliative care specialists
3. To reduce hospitalisation and enable more to live and die at home

What is the Gold Standards
Framework?
• System of care that promotes one GOLD standard of care for
ALL people nearing the end of their life
• Modified version of primary care Gold Standards Framework
(GSF)
• 4 main aims
• 1.
Improve quality of care for patients nearing the end of their lives
• 2.
Improve the coordination and collaboration with GP’s and
Primary Health Care Teams
• 3.
To reduce the numbers admitted to hospital in the last stages of life
• 4.
To share learning with key suggestions in improving endof-life care in care homes

GSF: The 7 Key Tasks (7 Cs)
C1 Communication
Supportive Care Register, MDT
Meetings, information
Advanced care planning (ACP) e.g.
Preferred priorities of care (PPC)
C2 Co-ordination
Identified co-ordinator for GSF, key worker for patient
C5 Continued Learning
Learning about conditions seen, audit, Significant Event
Analysis, reflective practice
C6 Carer Support
Practical, emotional, bereavement
C7 Care in dying phase
Liverpool Care Pathway for the
Dying Patient (LCP)
C3 Control of Symptoms
Assessment tools, guidelines,
Specialist Palliative Care Team
(SPCT)
C4 Continuity
Handover form, Out Of Hours protocol, liaison

Preparation, training, consolidation + accreditation
Stage I Preparation
3-6 months
 

Stage II Training workshops in 9 months
   
Enrolment of Care
Homes
Awareness
Raising
Meeting
ADA
Before
Local
Coordinators
Meetings
Workshop 1 Workshop 2 Workshop 3 Workshop 4
ADA
After
Stage III Consolidation + Sustainability
9 – 12 months
    

Ongoing
ADA
Final
Appraisal
GSFCH
Accreditation

1. Getting going
1.
Coding, Register
2.
Review Meeting,
3.
Coordinator Role
2. Moving on
1.
Advanced care
Planning
2.
Assessment of symptoms
3.
Out of hours continuity
3. Gaining Speed
1. Education and reflection
2. Carers, family, residents and staff support including Bereavement
3. Care in Final days
4. Cruising
1. Sustaining
2. Embedding
3. Extending - accreditation

GSF Coding of Residents in the Care Home
A
B
C
D
Years to Live
• Advance Care Plan discussion initiated.
• Holistic assessment
Months to Live
• Advance Care Plan in place.
• Holistic assessment.
Weeks to Live
Days to
Live
• GSF Out of Hours Handover Form
• Family discussion
• Pre emptive prescribing
• GP assessment
• Liverpool Care Pathway commenced by GP and Nursing staff
• Daily GSF Out of Hours Handover Form

• Better care toward the end of life
• A better death in accordance with their and their families wishes
• Fewer crisis or hospital admission
• Encourages proactive care with better advanced care planning
• Better symptom control
• Attention to psychological, social and spiritual needs
• Earlier discussion, more information and greater support given to family
• Access to effective out of hours care

• Improve care for residents
• Improves job satisfaction, clinical skills and knowledge
• Greater confidence when dealing with other health professionals
• Fewer residents going to hospital in last stages
• Receive training, support and resources
• Improve teamwork, both in practice and across teams
• Raise the profile of care home for palliative care in area

1. Leadership + support
2. Team-working
3. Documentation
4. Planning meetings
5. GP Collaboration
6. Advance Care Planning
7. Symptom control
8. Reduce hospitalisation
9. DNAR +VoD policies
10. Out of hours continuity
11. Anticipatory prescribing
12. Reflective practice+ audit
13. Education + training
14. Relatives
15. Care in final days
16. Bereavement
17. Dignity
18. Dementia
19. Spiritual care
20. Sustainability

• 1 Attitude awareness and approach –
• Better quality of care perceived
• Greater confidence and job satisfaction
• Immeasurable benefits – communication, teamwork, roles respected.
• Focus and proactive approach.
• Patterns of working, structure/processes
• Better organisation and consistency of standards, even under stress
• Fewer people slipping through the net – raising the baseline
• Better communication within and between teams, co-working with specialists
• Better recording, tracking of patients and organisation of care
• Patient Outcomes
• Reduced crises/hospital admission/length of stay
• More residents dying in place of their choosing
• More recorded advanced care planning discussions

• National GSF centre – Walsall
Judy Simkins GSF administrator.
judysimkins@wallsall.nhs.uk
Tel 01922 604666
Website.
www.goldstandardsframework.nhs.uk
NHS End of Life Care Programme www.endoflifecare.nhs.uk