The Royal College of General Practitioners (RCGP) has released “RCGP Commissioning Guidance in End of Life Care” to provide GPs and clinical commissioning groups (CCGs) with a six-step framework to support the delivery of improvements in the health, social care and voluntary and independent sectors, aligned with national policy and quality standards.
“The guidance has been produced to ensure that the needs of dying patients and those closest to them are paramount whilst services are commissioned and developed around them. It advocates a broad approach that is locally tailored but based on national policy, guidance and current expert thinking. It cautions that improvements in treating long term conditions, dementia, frailty and reducing hospitalisation cannot be achieved unless end of life care is seriously considered and integrated”.
The Six Steps
- Aim: all people approaching the end of life and their carers and family receive well-coordinated, high-quality care aligned with their wishes and preferences. Measured by reported satisfactory experience of care and key outcomes measures.
- Goals: in line with the Quality, Innovation, Productivity and Prevention (QIPP) agenda, delivering quality care which is good value and cost-effective.
- Sectors working together in collaboration: health (adult child, mental, physical, spiritual); social care (Local Authorities, Health and Wellbeing Boards); and voluntary / third sector / independent sector (hospice, charitable, independent and patient / users’ groups).
- Target areas overlapping with EOLC: EOLC must be included in these intersecting areas to enable effective improvement, i.e. long-term conditions, out of hospital care, elderly frail and people with dementia.
- Domains of care: the Gold Standards Framework’s (GSF).
- Standards for accreditation: with areas of outcome measures, specifically:
- Right person: identifying people nearing the end of life earlier and their carers.
- Right care: clinical care, provision of services, shared decision making, ACP, discussions, spiritual care.
- Right place: reducing hospitalisation, improving integrated cross-boundary care, improving community services; enabling more home deaths, reducing hospitalisation and out-of-hours crises.
- Right time: proactive care, care at each anticipated stage, care for the dying in the final days and care for the body after death.
- Every time: consistency for patients, carers and family, workforce and organisations; identifying and proactively supporting carers and family, and after death / in bereavement; enabling the workforce, ensuring training and support; knowledge, skills and attitudes; strategic planning and resourcing. Consistency of care, embedding in structures (operating framework, organisational quality assurance and accreditation, quality accounts and accountability).
Thomas, K. and Paynton, D. (2013). RCGP Commissioning Guidance in End of Life Care: Guidance for GPs, Clinical Commissioning Group advisers and commissioners in supporting better care for all people nearing the end of their life. London: Royal College of General Practitioners (RCGP), March 2013.
[A brief reference to this item features in Dementia and Elderly Care: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 7, May 2013].