GPs unable to meet end-of-life care demands, charity warns

Pressure on GP services has resulted in an inability to meet the needs of patients at the end of their life, a report has warned.

The findings from a nationally-representative survey of people affected by dying, death and bereavement in England and Wales, run by end-of-life charity Marie Curie, revealed that many respondents ‘felt support from their GP and other community-based services was inadequate’.

In response, the charity called for more resources to be allocated to general practice.

GPs were the most-contacted healthcare professional during a person’s last three months of life, according to the charity’s report, but despite this, one in five patients ‘had no contact with a GP’ during this time period.

The charity said that problems accessing GPs ‘were common’, with respondents describing ‘struggling to get through to GP surgeries’, to make appointments, and to arrange GP home visits.

The survey, which received responses from 1,179 people, found that:

• Respondents were least satisfied with the care provided from GPs; of those who received care from GPs, 36.7% assessed it as being very poor, poor, or fair, while 57.4% said GP care was good, very good, or excellent.
• Only around half of respondents said that healthcare professionals provided them and the person who died as much help as was needed in the last three months of life.
• GPs were rated the lowest: 207 (20.4%) did not consider that GPs provided sufficient help.

The report said: ‘The workforce issues among GPs, community and district nurses impact the system’s capacity to meet the needs for end of life care at home.

‘Without increases in resources for community-based primary and palliative care services, people with advanced illness and their families are likely to struggle with symptom management at home.’

The charity said the findings were ‘highly concerning’ in light of projected increases in the proportion of people dying at home.

‘As the number of people dying at home increases, unless there is a corresponding increase in capacity of primary and community care teams to support these deaths, quality of care is likely to suffer,’ the report added.

The report also included recommendations to:

• Make palliative and end-of-life care training a compulsory part of training and continuing professional development for all health and care workers;
• Fund all health and care professionals to receive training in and have time to follow clear national guidance on advance-care planning;
• Publish, at least every two years, independently-verified projections of future demand for the palliative and end-of-life care workforce.

Marie Curie chief executive Matthew Reed said: ‘We are calling on the new UK Government to act urgently to make the policy changes needed to ensure that everyone affected by dying, death and bereavement receives the best possible care and support, both now and in the future.’

RCGP chair Professor Kamila Hawthorne said that general practice ‘desperately’ needs improved staffing and funding in order to provide the high-quality end of life care that patients deserve.

She said: ‘Part of the essence of general practice is delivering holistic care to patients from a very young age right up until they are near or at the ends of their lives.

‘As such, being involved in the delivery of high-quality palliative and end of life care at this incredibly vulnerable time for patients – and supporting their families – is a priority for GPs and our teams. 

‘A lot of good end-of-life care is being delivered across the country. But the findings in this report are certainly concerning and reflect intense pressures right across the health and care services that are vital to ensuring patients receive the best possible end of life care, not least in general practice.

‘It is clear that those bearing the brunt of the underfunding and poor workforce planning that has led to these pressures are vulnerable patients and their families – and this must be addressed.’

The RCGP has worked with Marie Curie to develop the Daffodil Standards, which support GP practices to take steps to ensure patients at or nearing the end of their lives are receiving ‘the best possible care’.

Since the beginning of the programme, 1,900 practices from across the UK have participated, potentially benefitting an estimated 13.2 million patients, according to the RCGP.

‘But more widely, we desperately need improved staffing and funding in general practice in order to provide the high-quality end of life care our patients deserve – and this must be addressed as soon as possible,’ Professor Hawthorne said.