New Daffodil Standards and QOF: Supporting quality improvements in palliative and end of life care

  • Guest blog

March is the awareness month for Marie Curie’s Daffodil campaign. Part of this campaign includes the Daffodil Standards for palliative and end of life care, aimed at GP practices, and explained here by Dr Catherine Millington-Sanders, RCGP and Marie Curie National Clinical End of Life Care Champion and Clinical Lead for the Daffodil Standards, and Dr Simon Stockill, RCGP Clinical Champion for Quality Improvement.


One person dies every minute in the UK. With an ageing population, deaths – along with a greater need for palliative and end of life care and support – are set to rise by 17% by 2030. Evidence tells us the majority of people want to be cared for and die in their own home or care home, where possible. Most people who die in the community receive palliative and end of life care form general practice, without involvement of hospice care. We have the opportunity to make a bigger impact on people’s experiences towards the end of their lives with high quality, consistent, planned care, across GP practices and their networks.

Daffodil Standards

General practitioners and their teams play a vital role in caring for terminally ill or dying patients and in surveys they overwhelmingly identify this is a rewarding part of their job. That is why the Royal College of GPs and Marie Curie have worked together in partnership to create the Daffodil Standards. The Standards provide evidence-based guidance, tools and resources to help practices test what they are doing well and spot where they can make improvements.

New GP Contract

From 1 April, the new five-year GP Contract in England will be in place. NHS England, RCGP, NICE and the Health Foundation have worked together to produce a new quality improvement approach as part of the revised Quality Outcomes Framework (QOF). One of the two new priorities for this year is end of life care (EOLC) and it draws heavily on the new Daffodil Standards. Completing the QOF EOLC module is a firm foundation to achieving the full Daffodil Standards. Combined, both initiatives represent the most significant change in end of life care in general practice for a decade.

So, you may ask, what are the changes from 2018 to the new 2019 EOLC QOF?

Importantly, the pre-2019 QOF for EOLC equated to only 6 QOF points

IndicatorPointsAchievement thresholds
PC001: The contractor can demonstrate continuous quality improvement activity focused on end of life care as specified in the QOF guidance.3
Ongoing management:
PC002: The contractor has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed.




The new 2019 EOLC QOF offers 37 points.

IndicatorPointsAchievement thresholds
QI003: The contractor can demonstrate continuous quality improvement activity focused on end of life care as specified in the QOF guidance.27N/A
QI004: The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity as specified in the QOF guidance. This would usually include participating in a minimum of two network peer review meetings.10N/A


The new QOF approach recognises the profession’s long-maintained view that practice’s know their own patients the best. The focus on quality improvement and reflection as a practice, and peer review within the new Primary Care Networks, allows practices to assess and reflect on their baseline EOLC. This should inform the outcomes practices and networks plan to achieve, across the key areas.

Completing the new QOF End of Life Care module will establish GP practices well on the way to achieving the Daffodil Standards 

Practices are expected to focus their quality improvement activities in four key areas:

  1. Early identification of patients;
  2. Seamless, planned and coordinated care; offering patients timely and relevant personalised care and support plan discussions; documented and shared electronically
  3. Carer support – before and after death;
  4. Systems in place to monitor and improve, based on timely feedback of the experience of care from staff, patients and carers.

These four areas also align perfectly within with the eight core areas of quality improvement of the Daffodil Standards. Unlike the QOF, the Daffodil Standards are a virtual, scalable continuous learning and development programme designed to be completed over three years. They are flexible and manageable, so that those working in practices can fit them around their everyday work.

Signing up to the Daffodil Standards

The Standards are a free, voluntary resource with attributable CPD points. Practices signing up receive a free welcome pack, which includes a ‘Daffodil Mark’ certificate to display, showing their commitment to improving end of life care.

Furthermore, the CQC acknowledges the Daffodil Standards in providing a framework for evidence collection which practices will be able to use to demonstrate the quality of end of life care that they provide.

To sign up for free and receive a welcome pack, go to the RCGP website. For further information on QOF QI modules go to the NHS England website.

Last updated : 19 Mar 2019