Select Committee on Health Written Evidence


Letter from Dr Keri Thomas to the Chairman of the Committee (PC 24)


  I am writing to you as a GP, previously from Wakefield, with a particular interest in developing good palliative care services at home, and now as National Clinical Lead in Palliative Care CSC, working from Birmingham Cancer Network. Whilst still a GP in Wakefield, I wrote, developed and piloted The Gold Standards Framework in Community Palliative Care (now supported by Macmillan GSF Programme and the Cancer Services Collaborative). I am not sure whether you are aware that this actually began life in your nearby in West Yorkshire, and thought it might warm a Yorkshire heart to know of its origins! It was only thanks to the support and keenness of local Yorkshire GPs, District Nurses and my Health Authority that this developed into the National programme it is now.

  You may not remember, but we met on a few occasions whilst I was practising as a GP in Chapelthorpe, Wakefield (from 1992 to 2001), most notably at Wakefield Hospice's Tenth Anniversary Conference a few years ago. I also at the time worked as Macmillan GP Facilitator in cancer and palliative care in nearby Calderdale and Kirklees Health Authority based at Huddersfield, visiting primary health care teams and discussing the barriers and issues around improving care of the dying at home. Over a four year period this evolved into The Gold Standards Framework (GSF) aiming to crystallise the "Gold Standard" of care provided for patients in their homes by GPs and District Nurses with seven key standards or tasks. The main underlying thinking is to:

    1. Identify those patients in need of palliative/supportive care (on a supportive care register);

    2. Assess them according to their needs and preferences (preferred place of care/death); and

    3. Plan ahead, with anticipatory measures such as drugs in the home, handover from the out of hours provider etc, and at all levels to communicated this to the patient and carer and other teams including specialists involved.

  Now the GSF has taken off across the UK, with about 1,000 GP practice teams in England, a third of practices in Northern Ireland and about 300 in Scotland with a plan to roll it to all 1,000 practices. We hear comments from GPs that this puts them back in touch with the reason we came into healthcare, and that it has enabled DNs to do the job they had always wanted to do. And patients and carers greatly appreciate the well managed care they receive, and feel well supported at this most difficult time. We are fully evaluating the impact of The Framework (Warwick University GSF Evaluation Project) and find that many more patients are enabled to die where they choose, with fewer crises and admissions, better symptom assessment and control, better support for carer (with home pack) and better confidence and satisfaction.

  Improving palliative care affects hospital capacity and waiting times by reducing the number of inappropriate hospital admissions, decreasing length of stay and the hospital mortality rate, and ensures more effective use of specialists, enabling more people to die a dignified peaceful death where they choose.

  Originally funded by my NHS Health Authority in West Yorkshire, the Macmillan funded GSF programme has over the last year helped to support practices in this work. But this has a limited life, and work is now being handed back, quite rightly, to the NHS Cancer Network structure throughout England, to mainstream this into the NHS. It is being very well received by practices, with queues of practices wanting to join, and is supported by Professor Mike Richards, National Cancer Director, who wants this to be offered to every Primary Health Care Team in England. However, next year we will be running out of central funds to support this work. The main cost is in resources and funded time including that of local PCT facilitators, who develop this work locally.

  I am aware that John Reid's recent announcement of the £12 million may help to support Gold Standards Framework, along with the Liverpool Care Pathway—two initiatives that are very complementary and are both effective tools to improve care at home provided by the usual generalist health care worker. Most care for patients at the end of life is provided by generalists, and can therefore be optimised by the use of such tools, good access to learning and specialist support.

  I have also submitted evidence to the Palliative Care New Inquiry. This is a crucially important time to reconsider end of life care as a whole—it is too big a problem to ignore or to leave to chance, and we all hold responsibility to get it right for dying patients. This affects everyone—it will be us and our own families soon enough! I suggest we begin to follow the example of other countries in addressing the major problems of improving care at the end of life, beyond the remit of specialist palliative care.

  At this important time of reconsidering all care at the end of life in the light of this "looming epidemic", I would be very grateful if I could discuss this work with you further at some stage, both improving end of life care and the GSF. This work is a crucial vehicle to improve care at home, with all the inherent sequelae. It now requires central support for it to progress further, beyond initial start up funding by Macmillan and the Cancer Services Collaborative. It has been praised by Prof Joanne Lynn as the most effective palliative care collaborative currently on-going in the world, and has enabled many practices to kick start real improvements in their care for seriously ill patients. I could happily give more details if needed.

  I hope this makes you feel proud of the origin of this from Yorkshire—it was a great beginning and I hope it will continue to have a real effect in improving patient care towards the end of life.

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