Community nurses have reported feeling ‘obliged’ to take on an extended role within palliative care to cover work formerly done by GPs, but without additional pay, consultation or acknowledgement, according to a new study.
Research published in the British Journal of General Practice (BJGP) suggested that an increase in GP remote working and ‘workforce diversification’ within general practice was leaving community nurses feeling inadequately supported when it comes to end-of-life care.
The findings were based on 10 focus group interviews with 35 registered community nurses from across the UK – all of whom had provided end-of-life care for adult patients in the community in the past three months.
The study explored how two changes in primary care – including the shift towards remote working and the diversification of practice teams, by using other staff such as paramedics or physician associates – impacted the community nursing workforce.
Among study participants, researchers identified a ‘common thread’ linking concerns about the two changes, including that the relationship between community nurses and GPs had been damaged and that it was now ‘harder for nurses to get the senior clinical support they want’.
‘Without this support, nurses reported that they had felt obliged to extend their role to cover aspects of care formerly the remit of a GP, taking a lead in building the relationships with patients and their families that enabled shared decision making about complex problems,’ the study concluded.
‘Many expressed a wish for increased GP support with these difficult decisions, alongside a perception that their roles had been extended with inadequate consultation and attracted inadequate acknowledgement and remuneration.’
The report highlighted an ‘overreliance’ on community nurses and stressed that the profession both wanted and needed more support from GPs when managing the needs of patients who are receiving palliative care.
Although some participants recalled getting this support from palliative care specialists, most emphasised the need for ‘GP back-up’.
Many nurses described pride and satisfaction in taking the lead in providing end-of-life-care, although others shared their resentment at having to take on responsibilities which would otherwise have been taken on by GPs and also raised concerns about the risk to their professional registration as nurses.
‘There’s an overreliance on the community nurses especially to diagnose the problem and then the GPs will just react to whatever we’re telling them without actually seeing the patient face to face,’ one nurse warned.
Many nurses shared their resentment at being asked to take on additional work without receiving pay increases to reflect any new responsibilities.
‘There’s no recognition in our pay that we’re taking on basically the duties of a GP […] we are just so autonomous and with that comes a massive responsibility […] We are putting our registration at risk quite often […] for patient care,’ one nurse added.
Some shared how their workload had increased by taking the lead in person-centred care where community nursing teams saw remote provision of care by GPs to be ‘unsatisfactory’.
Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said the concerns raised by community nurses ‘are important and highlight the need for stronger inter-professional collaboration and communication’.
‘These issues are especially pressing in the context of increasing demand for palliative care, evolving models of primary care, and wider system pressures across the NHS.
‘GPs remain central to the coordination and delivery of high-quality, patient-centred care at the end of life. Their unique, longitudinal relationships with patients and families enable them to take a holistic view, supporting medical, psychological, and social needs. They are often the consistent presence across a patient’s journey, helping to ensure continuity of care and advocating for patient wishes.
‘However, GPs, like many in the NHS, are operating under unprecedented workload and resource pressures. The shift to larger practice footprints, remote consultations, and more complex caseloads can limit their ability to respond as promptly or consistently as community teams might expect.
‘To address these challenges meaningfully requires investment in integrated, team-based approaches to palliative care, where roles are clearly defined, communication is streamlined, and mutual respect underpins collaborative practice. Better-resourced systems, shared care planning tools, and more structured opportunities for joint decision-making will help ensure that GPs and community nurses can work together effectively, ultimately benefiting patients and their families during this critical time.’
A version of this article was first published by Pulse’s sister title Nursing in Practice
I thought senior nurses wanted to be autonomous.
If it is the case that GPs will prescribe or otherwise treat without seeing the patient then there are two consequences – a) the GP has taken responsibility and will have to answer if anything goes wrong and b) it implies that GPs trust their nursing colleagues.
I’d like to know what the role of these colleagues is, if it is not to assess and recommend treatment.
If only the Nurses had had the foresight to be ablel to see that the continued erosion of funding to general practice would inevitably result in reduced numbers of GPs and reduced access to those GPs, and voted differently in the last 20 years of government elections, we would be in a completely different, and more civilised, place right now, where GPs would continue to be supporting palliative and terminal patients directly and centrally, but too many other workers wanted more responsibility and control, and were happy to see funding taken away from GPs to facilitate their own importance, ratehr than investing to improve the service overall.