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How and why do GPs use specialist palliative care services?

Julia Addington-Hall

Department of Palliative Care and Policy, Guy's, King's and St. Thomas' School Medicine, King's College London, London

Stephen Barclay

General Practice and Primary Care Research Unit, University of Cambridge, Cambridge

Jill Briggs

Lead Practitioner for District Nursing, Lifespan, Healthcare NHS Trust, Cambridge

Ivan Cox

Macmillan GP Adviser in Cancer and Palliative Care, Macmillan Cancer Relief, Laurie Pike Health Centre, Birmingham

Lilian Daniels

Center for Palliative, Care and Oncology, University of Central England, Birmingham

David Millar

Macmillan GP Adviser in Cancer and Palliative Care, Macmillan Cancer Relief, Department of General Practice and Primary Care, University of Aberdeen, Aberdeen

This study presents findings on the interaction of generalists and specialists within palliative care. General practitioners (GPs) are central to community palliative care as most of the last year of a patient' life is spent at home under the care of the primary health care team. GPs see few palliative care patients each year, however, and access to specialist palliative care services for support, advice and referral can be important particularly to support patients who wish to die at home. The aim of this study was to explore GP use of and attitudes towards specialist palliative care services through semi-structured interviews in inner city, urban and rural areas. It was part of a longitudinal evaluation of an educational intervention, and the quantitative components are reported elsewhere. Sixty-three GPs were interviewed, having been sampled randomly from inner city, urban and rural health authority district lists. While most interviewees reported using specialist palliative care services as a resource, other models of use included working together as an extended team, seldom using such services and handing over care or responsibility entirely. Availability of services clearly shaped use, but previous experience and expectations of easy access were also important. Patterns of use were not necessarily fixed, but dependent also on the differing needs of and wishes of patients and carers. Specialist palliative care services need to be aware of such variations in ways of working and to consider the implications for the capacity and flexibility of both primary care and specialist service provision.

Key Words: general practice • palliative care • primary care • service provision • specialist palliative care services

Palliative Medicine, Vol. 16, No. 3, 241-246 (2002)
DOI: 10.1191/0269216302pm534oa


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