Providing end-of-life care in general practice : findings of a national GP questionnaire survey

Background: With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC). Aim: To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. Design and setting: A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. Method: Responses were analysed using descriptive statistics and an inductive thematic analysis. Results: Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care — which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors — with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management — including effective symptom-control and access to specialist palliative care services; and expertise and training — the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. Conclusion: The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care