Care for the dying needs to be improved say UK GPs

GPs think more needs to be done to improve the quality of end-of-life care in the community.

That's one of the insights gained from a survey of British GPs conducted by the University of Warwick and the Royal College of General Practitioners.

More than 500 doctors completed the survey about end-of-life care (EOLC) in general practice. The research was led by Dr Sarah Mitchell an NIHR doctoral research fellow at Warwick Medical School, University of Warwick and Dr Catherine Millington-Sanders, Marie Curie/RCGP Clinical Champion for EOLC

Dr Mitchell said: "The findings suggest that GPs perceive limited progress in terms of enhancing the quality of end-of-life care that is delivered in primary care. This must be considered in terms of the increasing number of patients who require EOLC, and a pressured and changing primary care environment in the UK."

Hospices

The research, Providing end-of-life care in general practice: findings of a national GP questionnaire survey has been published in the British Journal of General Practice. In addition to general practice, the survey respondents worked in a wide range of settings including care homes, hospices, care homes for people with learning disabilities, out-of-hours services, genitourinary medicine clinics, prisons, and geriatric services.

Four clear areas of concern for GPs emerged from the survey: continuity of care; patient and family factors; medical management; and expertise and training.

Continuity of care was identified as being of vital importance in the provision of EOLC in primary care. Only 122 out of 492 (24.8%) responders stated that they always had the chance to discuss EOLC wishes with patients. As one of the survey respondents wrote;

"Time to spend with patients which we do not have and time to spend with patients which has been eroded by increasing workload in all areas. 10 minutes in surgery and a little more on a home visit to make life enhancing decisions and arrangements is insufficient even if we are "EOL experts".'

GPs also stated they had concerns about the lack of time to have sensitive care planning discussions with patients and families. In addition they highlighted the issue of the timing of those conversations, particularly for those with non-malignant disease. This was felt to lead to a lack of responsiveness to patients' wishes, as well as avoidable pressure on the emergency care system, particularly in the context of lack of integration with out of hours care.

Palliative care

Issues relating to adequate symptom control, access to specialist palliative care services including hospice beds, and access to medication were described. Symptom-control. Sudden deteriorations in a patient's condition and inadequate symptom-control were identified as a consequence of avoidable delays in clinical assessment and accessing or administering medication.

The fourth area of concern, lack of experience and a lack of training was mentioned frequently in relation to GPs and community staff, including staff in care homes. When asked about this 19 out of 513 (3.7%) stated that they had had no training in the delivery of EOLC, and 112 out of 513 (21.8%) stated they had received inadequate training. Adequate training was reported by 321 out of 513 (62.6%) responders. The remaining 61 participants (11.9%) answered 'other' to this question highlighting the need to actively seek out training courses in EOLC.

Dr Mitchell said: "Service delivery concerns in EOLC should remain a priority area for policymakers and researchers. With primary care in the UK now under unprecedented pressure the way in which high-quality EOLC in the community is achieved requires urgent consideration.

"This is particularly relevant as 'new models' of primary care emerge, such as GP super-practices and federations In this context, this questionnaire survey was designed to capture an up-to-date insight into the experiences of GPs providing EOLC in the community".

Article: Providing end-of-life care in general practice: findings of a national GP questionnaire survey, Sarah Mitchell, Joelle Loew, Catherine Millington-Sanders, Jeremy Dale, British Journal of General Practice, doi: 10.3399/bjgp16X686113, published 6 July 2016.