How the changing role of the GP is impacting community palliative care: a qualitative interview study

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

4C.2

Presenter:

Tanuka Palit

Co-authors:

Bowers B (2), Chamberlain C (1), McCabe C (3) , Mitchell S (4), Selman LE (1) , Pocock L (1)

Author institutions:

(1) University of Bristol, Population Health Sciences, Palliative and End of Life Care Research Group, (2) Primary Care Unit - University of Cambridge, (3) School of Health and Social Wellbeing, University of the West of England, Bristol, (4) University of Leeds in the Division of Primary Care

Problem

GPs are known to provide continuity and coordination of care within their role. Together with community nurses and specialist palliative care teams, GPs provide the majority of palliative care in private homes. With an ageing population and more patients dying at home, good community palliative care provision has never been more important. This was recognised by the 2022 UK Health and Care Act that now expects all Integrated Care Systems (ICS) to commission palliative care services.Alongside increasing patient demand and a shrinking workforce, GPs are making changes to their working practice, including alternative ways of providing home visits. It is unclear how this has impacted the care for patients dying at home. This qualitative interview study explores the changing GP role in palliative care and how this has affected other healthcare professionals caring for patients receiving palliative care in the community.

Approach

The study was carried out across two ICS areas in South West England. Purposive sampling was used to recruit participants from primary care, community nursing and specialist palliative care. Participants took part in semi-structured, audio-recorded interviews over video conferencing software. Recordings were transcribed verbatim, and analysed using a reflexive, inductive thematic approach.

Findings

Twenty-two participants took part, including seven GPs and one GP nurse practitioner, seven nurses and one healthcare assistant from the community nursing team, and six specialist palliative care nurses.Three key themes were identified: 1. Proactive versus reactive GP. Whilst some GPs believe they still offer continuity of care for patients, all participants describe GPs as ‘firefighting’. A number of system, patient and GP factors were perceived to contribute to more reactive working. Examples of these factors were part-time working of GPs, increasing frailty and multimorbidity of patients, and changes to rules around death certification. 2. Loss of home visiting role. Reduced home visiting may have changed the GP-patient relationship, and led to a reliance on other roles such as paramedics and community nurses to carry out visits. 3. Fragile GP and community nursing relationship. Changes to GP visiting roles and the reduced accessibility of community nursing teams may have caused strains in relationships between these professionals.

Consequences

These findings highlight the desire for GPs to maintain a proactive approach when managing patients towards the end-of-life to ensure good continuity. Improved GP working with paramedics and community nurses may replace some home visits, and support the firefighting GP. Furthermore, it is important that GPs retain close working relationships with community nurses. Greater community nurse presence at multidisciplinary team meetings and systems to facilitate joint working with community healthcare professionals may help. Further research is needed to understand patient and families’ experiences of the changing role of the GP and its impact on end-of-life care.

Submitted by:

tanuka palit

Funding acknowledgement:

NIHR GP Academic Clinical Fellowship