People with cancer need good access to palliative care to relieve distressing symptoms, but some get better access than others. Developed in Australia, the Needs Assessment Tool - Progressive Disease Cancer (NAT:PD-C) is a tested, "everyday practice" instrument to help doctors and nurses identify patients' and their caregivers' palliative care needs. It distinguishes needs that can be managed by the usual clinical team and those requiring specialist palliative care referral. We have adapted the NAT:PD-C for use in UK General Practices within a current YCR-funded programme. Now we need to test whether regular use of the NAT:PD-C by GPs improves patient care. During this programme, we will: a) produce a computer-based NAT:PD-C linked to GP systems, b) complete a training package using videos recorded in our current project, c) conduct a pilot trial leading onto d) conduct a full cluster randomized controlled trial to determine whether routine use of NAT:PD-C results in fewer unmet palliative care needs for patients and caregivers, support for their preferred place of care/death and is cost-effective. We will also assess GPs' palliative care training needs and explore the factors which will help or hinder use of the NAT:PD-C in routine clinical practice.