COPD kills about 25 000 people per year in England and Wales (DoH 2011). NICE guidelines (2010) suggest patients with end stage COPD should have access to palliative services. The national COPD audit showed on-site palliative care provision has increased from 50% in 2008 to 87% in 2014 but less is known about out of hospital provision. The Gold Standard Framework (GSF) prognostic indicators assist clinicians to identify patients who are approaching end of life at an earlier stage enabling appropriate interventions to take place. These patients are more likely to receive well-coordinated and high quality care (GSF/RCGP 2011). The aim of our study was to map the number of QoF registered COPD patients, the frequency of COPD specific GSF indicators, the number included on primary palliative care registers (≥2 GSF prognostic indicators) and the number reviewed by palliative care.

Methods A multidisciplinary group with membership from CCG, acute trust, hospice and the community team oversaw the project. After a data sharing agreement was completed, data was collated from across all health care sites in our area for COPD patients enabling us to confirm the number and type of GSF prognostic indicators for each patient and healthcare activity including palliative care reviews.

Results As of March 2016 there were 4999 COPD patients; 52% were male with an average age of 69.2 years. 25.7% of the patients (n=1285) had ≥1 GSF prognostic indicator. The most common indicator was MRC dyspnoea score of 4/5 (65.5%), followed by body mass index <20 (25.7%). Of the 294 patients with ≥2 GSF prognostic indicators 14.6% were on the GP palliative care register. 19.0% of the 294 patients had been reviewed by the palliative care team.

Conclusion GSF prognostic indicators in COPD are prevalent with breathlessness being the most common. Only a small proportion of appropriate patients were included on the palliative care register (14.6%) with more being seen by palliative care teams than on the registers. Further work is needed to ensure effective communication and education is provided across the whole health care system to identify patients earlier who are approaching end of life.