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GP opt-out hitting palliative care

GPs' out-of-hours opt-out is 'compromising' palliative care and may further reduce the number of patients able to die at home, researchers warn.

A new study of palliative care services for cancer found a shake-up was needed in the UK to reverse a decline in the number of home deaths.

But the researchers said the situation was likely to get worse and not better with the advent of the GP contract.

The systematic review, published online by the BMJ, found number of homes visits was an important factor influencing patients' place of death.

Use of home care increased the chance of death at home by between 1.4-fold and 5.1-fold, and greater intensity of home-care by 1.1-fold to 8.7-fold.

The systematic review, covering 58 studies and 1.5 million patients in 13 countries, also found dying at home was less common in the UK than in two other countries where direct comparison was possible.

Study leader Professor Irene Higginson, head of palliative care policy and rehabilitation at King's College London, said: 'The number of home deaths in the UK has fallen over the last 10 years, from 27 to 22 per cent. This needs to be addressed.'

She said the opt-out from out-of-hours in the GP contract posed a significant threat to the provision of palliative care. 'It is worrying when key areas can be potentially compromised as a result of changes in the organisation of the health system.

'It's still early days, but the opt-out may further the decline in home deaths. Palliative care patients need to be able to have care available day and night. In the UK this is compromised.'

A further 16 factors were identified as influencing the place of death, including length of illness, support from relatives and preference for home death (see box).

Jo Webber, deputy policy director at the NHS Confederation, which recently issued a major evaluation of palliative care in the UK, said: 'This backs up our findings that when people have lots of support they have more choice.'

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