1. End of Life Care in General Practice: A National Survey of GPs
Sarah Mitchell, Joelle Loew, Catherine Millington-Sanders, Jeremy Dale
Warwick Medical School, University of Warwick, Coventry, CV4 7AL
Royal College of General Practitioners Clinical Innovation and Research Centre, London, NW1
Introduction
The numbers of people living in the community with complex life-limiting multi-morbidity in the community is increasing. GPs play a pivotal role in the provision of palliative and end-of-life care (EOLC). However with the GP workforce under unprecedented pressure, consideration must be given to improving the organisation and delivery of high quality palliative and EOLC. .
Method
A web-based national UK survey was circulated via Royal College of General Practitioners, NHS, Marie Curie and Macmillan networks. Responses were analysed using descriptive statistics and an inductive thematic analysis.
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Results
516 GPs responded, and were widely distributed in terms of practice location. 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data:
Effective symptom-control and access to specialist palliative care services, including the availability of hospice beds.
A need for training and professional development to enhance knowledge, skills and attitudes towards EOLC.
Challenges include early identification of palliative care needs and recognition of the end of life; opportunity for care planning discussions and the provision support for families.
Difficult to achieve due to resource concerns including time, staff numbers, increasing primary care workload and lack of funding. Effective multi-disciplinary team working and communication were considered essential.
Out of hours arrangements were considered problematic.
Continuity of Care
Patient and Family Factors
Clinical Management
Expertise and Training
Results
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Conclusion
The survey findings are in keeping with previous research, suggesting that limited progress has been made to enhance the quality of EOLC. There are enduring priorities for policy, commissioning, practice development and research, in the context of a pressured and changing primary care environment in the UK.
What this study adds
The survey provides insight into current experiences of GPs delivering EOLC, and suggest that GPs perceive ongoing service delivery concerns in EOLC.
The contribution of GPs in the delivery of EOLC should remain a priority area for policy-makers and researchers.
Mitchell S, Loew J, Millington-Sanders C, Dale J. (2016) “Providing end-of-life care in general practice: findings of a national GP survey” Br J Gen Pract doi: /bjgp16X686113