Case study:

29 November 2010

Sheffield’s end of life care strategy for the community

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Key points

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Over the last year Sheffield has been working to improve end of life care in the community and to enable people to die in their preferred place of care.

The initiatives follow an End of Life Care Summit hosted in the city in 2009 to bring together all key stakeholders to raise awareness around death and dying, discuss implementation of the National End of Life Care Strategy and foster a whole systems approach to this area of care.

Sheffield also participated in a number of national and local studies to better understand end of life care in the city (see 1,2,3 below). Collectively these have contributed to a better understanding of end of life care locally and helped identify areas where there is real scope for improvement.

One key finding was that up to 40% of the patients who died in hospital during the audited period did not have a medical need to be in hospital, and for the majority of those it would have been possible to commission a more appropriate service.

To take forward improvements in the quality of end of life care across primary care, NHS Sheffield and practice-based commissioning (PBC) consortia in the city have embarked on a programme of collaborative work. This programme is particularly focused on implementing best practice, using the principles from the Gold Standards Framework (GSF).

A partnership approach was also established with Macmillan to secure clinical facilitation for end of life care. A large protected learning event for over 200 GPs was held in the city with local clinicians presenting and supporting their peers on best practice for end of life care. This explored the principles underpinning the GSF, demystifying advance care planning and introducing Sheffield’s revised ‘End of Life Care Pathway for the Last Days of Life’, which is now growing in use across all care settings.

Further consortia-based events are taking place between GPs and their community nursing colleagues at a very local level. The aim is to increase the number of people on practices’ palliative care registers who can benefit from advance care planning.

One key local priority is to improve anticipatory care for the frail elderly population who are over 75. GP practices are developing electronic registers of the 75+ population at risk of hospital admission in the next 12 months, using risk stratification tools. Ninety per cent of the city’s practices have signed up and around 33,000 older people will be risk assessed in 2010-11, excluding those living in care homes. The registers will be used to ensure older people at risk receive appropriate medical interventions to reduce the chance of hospital admission as well as identifying those who should be added to palliative care registers.

Sheffield has also put in place a Local Enhanced Service (LES) for care homes which aligns a GP practice with every home and provides a named GP to undertake a weekly visit to the home and a care plan for every resident. This includes advance care planning. The LES goes to around 4,000 residents in 85 homes caring for the elderly.

1 A Review of the Provision of End of Life Care services in Sheffield: National Audit Office Whole System Review 2008

2 Identifying Alternatives to Hospital for People at the End of Life – Draft Report of Findings. The Balance of Care Group in association with the NAO. July 2008

3 Improving Supportive and Palliative Care for Adults with Cancer in Primary Care: a National Survey of General Practices. University of Sheffield. May 2008

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