End-of-life care compromised by 'fractured' primary care
By Lilian Anekwe
A major report into end-of-life care from the King's Fund has stressed the importance of continuity of care and questions the value of newer GP models including polysystems and polyclinics.
Their report on end-of-life care is the first in a set of fourteen reports due from their 18-month inquiry into GP care.
Pulse reported in May that the inquiry, led by senior GPs and academics, would challenge the political consensus around the measurement of GP quality of care and attempt to ‘capture the spirit of general practice'.
The report, which includes a literature review and case studies of ‘high and low performance', highlighted continuity of GP care, and the lack of it is provided by out-of-hours services, as a key theme in providing high-quality end of life care in general practice.
‘Patients consider good out-of-hours care to be important, and ideally they prefer to receive it from their regular GPs. Historically this care has been delivered by an extended primary care team, but recent organisations, including separation of provider services and other factors, have fractured this multidisciplinary team, threatening the capacity of a more personally model of care in out-of-hours periods….All this means that patients are less likely to receive consistent out-of-hours care.'
‘It remains to be seen whether newer initiatives such as polyclinics, polysystems, integrated care organisations and social enterprises, can reverse this unhelpful disconnection and reinvent the primary care team, with its ability to provide more integrated care across out of hours periods.'
It found that many GPs said they believe the availability and quantity of out of hours care for patients nearing the end-of-life is ‘often inadequate' and patients and carers were ‘less positive' about the care that they receive from out-of-hours services than from their GPs.
It also flags up the difficulties GPs face when taking on end of life care, including a ‘lack of confidence', the ‘discomfort' a GP feels when having potentially difficulty conversations with patients and carer, and doubt about to whom to offer bereavement care.
It rules out the current crude measures of the quality of end of life care that focus on structures and processes ‘with little recognition of outcomes or experiences'. Instead, GPs should be measured using ‘more qualitative or experiential indicators of quality that measure patient and/or carer satisfaction.'
Dr Rachel Addicott, senior research fellow at The King's Fund concluded the report by saying: ‘The ageing population and challenging financial context demonstrate significant challenges for the organisation and delivery of end of life care across England. GPs will be expected to do more, with less resource.
‘These findings build the case for a model that promotes greater collaboration across GPs and other primary care professionals – through networks or models of federated GP practices – to co-ordinate care that allows for, and offers, a co-ordinated pathway that is aware of and meets individual patient care preferences.'End-of-life care compromised by 'fractured' primary care, finds major report