Liverpool Care Pathway - QOF... QOF... Bless You!

QOF... QOF... Say no more..!








GP palliative care registers, otherwise known as the one percent, continue for 2014/15. This is NHS Employers –

The 3 points award remains unchanged from 2013/14 and there is no threshold target to achieve.

PC – rationale for inclusion of indicator set

Palliative care is the active total care of patients with life-limiting disease and their families by a multi-professional team. The first National End of Life Care (EoLC) Strategy215

- NHS Employers

• since the introduction of this indicator set over 99 per cent of practices now using a palliative care register was published in July 2008. It builds on work such as the NHS cancer plan 2000, NICE guidance 2004 and NHS EOLC programme 2005.


The way primary care teams provide palliative care in the last months of life has changed and developed extensively in recent years with:

• specific emphasis on the inclusion of patients with non-malignant disease and of all ages since April 2008

• patients and carers being offered more choice regarding their priorities and preferences for care including their preferred place of care in the last days of life (evidence shows that more patients achieve a home death if they have expressed a wish to do so)

• increasing use of anticipatory prescribing to enable rapid control of symptoms if needed and a protocol or integrated care pathway for the final days of life

• identification of areas needing improvement by the NAO e.g. unnecessary hospital admissions during the last months of life
 The National EoLC Strategy suggests that all contractors adopt a systematic approach to EoLC and work to develop measures and markers of good care. They recommend the Gold Standards Framework (GSF) and the associated After Death Analysis (ADA) as examples of good practice. Evidence suggests that over 60 per cent of practices across the UK now use GSF to some degree to improve provision of Palliative care by their primary care team.

PC 001.1 Rationale

About one per cent of the population in the UK die each year (over half a million), with an average of 20 deaths per GP per year. A quarter of all deaths are due to cancer, a third from organ failure, a third from frailty or dementia and only one twelfth of patients have a sudden death. It may therefore be possible to predict the majority of deaths, however, this is difficult and errors occur 30 per cent of the time. Two thirds of errors are based on over optimism and one third on pessimism. However, the considerable benefits of identifying these patients include providing the best health and social care to both patients and families and avoiding crises, by prioritising them and anticipating need.

 Identifying patients in need of palliative care, assessing their needs and preferences and proactively planning their care, are the key steps in the provision of high quality care at the end of life in general practice. This indicator set is focused on the maintenance of a register (identifying the patients) and on regular multidisciplinary meetings where the team can ensure that all aspects of a patient's care have been assessed and future care can be co-ordinated and planned proactively217

1. Their death in the next 12 months can be reasonably predicted (rather than trying to predict, clinicians often find it easier to ask 'the 'surprise question' - 'Would I be surprised if this patient were still alive in 12 months?') A patient is included on the register if any of the following apply:

2. They have advanced or irreversible disease and clinical indicators of progressive deterioration and thereby a need for palliative care e.g. they have one core and one disease specific indicator in accordance with the GSF Prognostic Indicators Guidance (see QOF section of the GSF website)

"Evidence suggests that over 60 per cent of practices across the UK now use GSF to some degree to improve provision of Palliative care by their primary care team."

GSF is flying.

"Rather than trying to predict, clinicians often find it easier to ask 'the 'surprise question' - 'Would I be surprised if this patient were still alive in 12 months?'".

That's the GSF. That's the Barton Method...

Footnote -

The Quality and Outcomes Framework (QOF) rewards practices for the provision of 'quality care' and helps to standardise improvements in the delivery of clinical care. It was introduced as part of the new GMS contract in 2004.- NHS Employers