Background, development and update process of PIG

Development of this guidance paper. This guidance was originally commissioned from the GSF Team in 2004 to support GPs with inclusion of appropriate patients on their QOF Palliative Care Registers i.e. those considered to be in the final 12 months of life. It is regularly revised following extensive consultation with specialist clinical and disease groups, palliative care specialists and GPs in the Royal College of General Practitioners. Particular thanks go to the NHS End of Life Care Programme and University of Edinburgh team for their help.

Since publication, this Guidance has been widely used by clinicians in many sectors in the UK and abroad. A list of detailed references is available. This is one of several tools available from The GSF Centre for End of Life Care and further details on best use, IT support and further developments can be obtained from the GSF Centre.

Background, Resources and Further Reading:

For the revision 2015-17, we are grateful to the expert contributors to this guidance, including responses from British Geriatric Society, British Thoracic Society, NHS England, Royal College of General Practitioners, Royal College of Physicians, Motor Neurone Disease Society, Parkinson’s Society, Dementia UK, Alzheimer’s Society and others. 


Other references include
National Primary Care Snapshot Audit (2009/2010) DH report
NHS End of life care programme:
NHS Department of Health. End of Life Care Strategy (2008) P51, 3.22
GMC End of Life Care:
National audit office report Nov 08.
British Geriatrics Society.
The ‘Surprise question’.  Living Long in Fragile Health: Lynn J, 2005
Dying Matters- Find the 1% campaign –

Frameworks for Implementation (2010) from the End of Life Care Programmes -

Renal advisory group of the NSF, British Renal Society, and British Transplant Society.
Barthel Score:  Barthel's index of activities of daily living (BAI),
Glare P (2011). Predicting and communicating prognosis in palliative care. BMJ;343:d5171
Glare P, Sinclair CT (2008). Palliative medicine review: prognostication. J Palliat Med;11;84-103
Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L (2011) Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ;343:d4920
McDaid P (2011) Quick Guide to Identifying Patients, Islington PCT, (personal communication)
Quinn TJ, McArthur K, Ellis G, Stott DJ (2011).Functional assessment in older people. BMJ ;343:d4681
Quinn TJ, Langhorne P, Stott DJ (2011). Barthel index for stroke trials: development, properties and application. Stroke; 42:1146-51
SPICT Guidance University of Edinburgh (2010). Supportive and Palliative Care Indicators tool (SPCIT)
SPOTLIGHT: Palliative care beyond cancer: Recognising and managing key transitions in end of life care: Boyd K, Murray S BMJ 341
Watson M, Lucas C, Hoy A, Back I (2005) Oxford Handbook of Palliative Care. Oxford University Press