The Royal College of GPs, in partnership with the end of life charity Marie Curie, has enhanced the ‘Daffodil Standards’ to support GPs and their teams in providing consistently high-quality palliative and end of life care specifically focusing on older patients living in care homes.
The new guidance, specifically relating to older people living in care homes, has been co-developed with frontline GPs, members of the multi-disciplinary practice team and other relevant care providers as a free, quality-improvement programme. The care home standards were already in development before the outbreak of COVID-19 and their use is not limited to the care of patients during the pandemic.
They build on the success of the wider Daffodil Standards programme, launched last year by the College and Marie Curie, offering a set of standards that GP practices can sign up to as a commitment to continuously improve the quality of palliative and end of life care they deliver for patients. So far, approximately, one in six practices in the UK have signed up.
The new additional Daffodil Standards complement the original programme but are standalone and tailored to the care of patients in care homes who are coming to the end of their lives. Engagement with the original standards is not a prerequisite to signing up.
Recognising the intense pressures currently facing general practice, the new standards are designed to be as streamlined and supportive as possible for GP practices. They focus on continuous improvement by providing GPs and members of the practice team involved in supporting older patients living in care homes with an easy-to-navigate framework to build on the care their practice already provides.
Daffodil Standards for Older Patients Living in Care Homes is free to sign up to and available as a downloadable, self-assessment tool. It consists of two levels – the first looking at processes in place and the second looking at whether these deliver what patients and their families want and need.
The two levels are:
- Level 1: Core Essentials – Internal practice systems to enable consistency of care
Providing guidance on implementing robust processes to best support patients in care homes, as well as their families. The framework emphasises the importance of extending the multidisciplinary team to include those who work within care homes and taking a holistic approach to determine what matters most to individual care home residents.
- Level 2: Enhanced – Improving communication, shared planning and compassionate care
This level encourages reflection to ensure that the processes in place meet the needs of older patients and their families, and that the most appropriate professionals are involved. This framework also supports the involvement of robust planning and communications with family members of care home residents.
Each level is tiered to accommodate every GP practice, regardless of the point it is starting from, and its capacity to make quality improvements. This aims to encourage a consistency of care amongst care homes, supporting all GPs and their teams to reach the same objective.
Practices that sign up to the new Daffodil Standards will be encouraged to feedback in real time in order to assess how the standards work in practice and based on that feedback, the Standards will be reviewed within three-to-six months.
Dr Catherine Millington-Sanders, RCGP and Marie Curie National Clinical Champion for End of Life Care, said: “All patients who require palliative and end of life care are vulnerable, but those who live in care homes are some of our most vulnerable, which is why Marie Curie and the RCGP have created a focus of the Daffodil Standards, tailored to their needs, and the needs of their family members.
“The Standards have been developed by a diverse group of organisations, all committed to delivering the best possible care to older patients who live in care homes. Our aim is to minimise variation in the end of life care they receive – and to support GPs and their multidisciplinary teams who are delivering their care, in partnership with care home staff.
“General practice plays a crucial role in delivering high quality end of life care to their patients in care homes. Prior to the pandemic, we planned to develop the Daffodil Standards to enable a focus on older patients in care homes and the pandemic has brought the importance of this work into sharp focus. As GPs and their teams press on in managing COVID-19 and delivering vital general practice services under difficult circumstances, this framework aims to support GP practices by confirming robust leadership and systems to support the individual older patient’s health – this should reassure both care home residents and their families alike.”
Simon Jones, Marie Curie Director of Community Engagement, said: “We have always known how important care homes are in end of life care for very many people and that has been brought home to us even stronger this year. But care homes should not be places where people go to die but rather to squeeze every scrap of life out the time they have left. The role of the GP and their practice staff is central to care and support in care homes. These new Standards builds on the existing Daffodil Standards in a way that will help GPs and practice staff in a crucial part of their work.”
Dr Dawne Garrett, RCN Professional Lead for the Care of Older People and Dementia, said: “Delivering high quality end-of-life care is a fundamental role nursing staff play in care homes. It will remain essential to the work of the nursing team in care homes.
“Nursing staff ensure older patients in care home settings receive the best possible care. These new standards will allow everyone working in care to ensure the quality of their care remains high. We hope nursing staff will be able to use these resources to see ways to innovate the care they give to benefit all service users.”
Ian Turner, Executive Chair of the Registered Nursing Home Association, said: “Care Homes will wish to work with their clinical lead and other GP’s to use the daffodil standard to encourage more personalised care for their residents. I therefore welcome the introduction of this standard and look forward to its widespread implementation across the UK. For those in England this also aligns with the Enhanced Health in Care Homes initiative.”