Guest opinion - Six steps to improving end-of-life care

Birth and death are the only two things that are inevitable about life, for all of us.

But while there is a lot of focus on choice and planning for a good birth, the same cannot always be said for what happens to us at the end of life.

The UK has a strong tradition of excellence in palliative care, especially for those with cancer, but the challenge we face as GP providers and commissioners is to move beyond this to the greater population who need our help.

End-of-life care has long been a priority for the RCGP and our strategy and patient charter, produced in 2009, have been well-received by patients and the profession alike.

We are now addressing the complexities of commissioning for a better quality of end-of-life care in local settings and this month saw the launch of our new guidance to help deliver practical improvements.

RCGP Commissioning Guidance in End of Life Care ( provides a six-step framework to support commissioners working across the health, social care and voluntary/independent sectors. It is locally tailored but based on national policy. The six steps are local aims; goals in line with the Quality, Innovation, Productivity and Prevention agenda; working together; target areas that overlap with end-of-life care; domains of care and areas of outcome measures.

The guidance brings together existing good practice and signposts to a range of resources and documents that are already available. It also provides useful case histories, demonstrating how good end-of-life care can be achieved.

The authors, Professor Keri Thomas, RCGP end-of-life care lead, and Dr David Paynton, RCGP commissioning lead, caution 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.

This will ensure we deliver key outcome measures. Most importantly, it means we can provide the right care, at the right time, in the place the patient chooses. Who could ask for a better end?

Professor Gerada is a GP in London.

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