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Out of hours services perhaps need review
- john sharvill (1 January 2005)
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Primary palliative care services must be resourced better by both day and night
- Scott A Murray, Kirsty Boyd, Aziz Sheikh, Keri Thomas, and Irene J Higginson (30 January 2005)
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john sharvill, gp deal kent
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I agree that the new out of hours arrangemnts are not designed for palliative care. They could though be improved. At present we provide (and most out of hours is still provided by GP trained drs even if not in their own areas) a rapidish response for those whose demands may be greater than their needs. This is somewhat at odds for the service to those in need. If the services were to be designed so that the sick were seen rather than diverted to 999 calls and the dying were cared for as priorities primary care could and in my view should be able to provide a first class service for those dying at home. An alternative might be a local contract with practices to provide a locally enhanced 24 hr palliative care approach in their locality for those in the final weeks of their life. Competing interests: None declared |
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Scott A Murray, Clinical Reader Primary Palliative Care Research Group, Community Health Sciences, University of Edinburgh, EH8 9DX, Kirsty Boyd, Aziz Sheikh, Keri Thomas, and Irene J Higginson
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Editor- We welcome Guthrie’s helpful response to our editorial (6 November) pointing out that the new out-of-hours organisations are now responsible for 75% of the week’s on-call, while only 25% is the responsibility of Primary Care Teams working during the day.(1) This of course means that it is general practitioners and district nurses working out-of-hours who are frequently attending people dying at home. Unfortunately such busy organisations are often extremely stretched to deal with the diverse out-of-hours workload, and hand-over forms for identifying palliative care patients who potentially could deteriorate acutely are in our experience rarely in place. Progress is being made by some practices which routinely notify NHS24 in Scotland or NHS Direct in England of such patients, as recommended for instance in the Gold Standards Framework.(2) We do not yet know what effect the new call-centre triaging and accompanying out-of-hours arrangements will have on helping patients to die at home, if they so wish. Call-centre care can be problematic, and perceived as impersonal.(3) This underscores the urgent need to develop plans for provision of 24 hour care for dying people. As out-of-hours services continue to evolve, we must not lose sight of attempting to meet the last wishes of our patients, many of whom would like to die at home if they could. This means, as Guthrie highlights, we need to have more community nurses and social support available out-of- hours. Ways of targeting additional support at home for those with particularly complex needs should be explored, with community providers being encouraged to make greater use the out-of-hours advice available from specialist palliative care services. Otherwise, as Levack and colleagues suggest, only those with the fewest symptoms and greatest personal resources will be able to die at home. (4,5) 1. Guthrie CI. Developing primary palliative care: Changed role of general practitioners has been taken into account BMJ 2005:330;42-42 2. Thomas K. Caring for the dying at home. Companions on a journey. Oxford: Radcliffe Medical Press, 2003 3. Douglas D. Out of hours cover. BMJ 2005:330;263-63 4. Levack P, Dryden H, Paterson F. Developing primary palliative care: community palliative care services are not sufficiently funded. BMJ 2005:330; 42-43 5. Higginson IJ, Jarman B, Astin P, Dolan S. Do social factors affect where patients die: an analysis of 10 years of cancer deaths in England. J Pub Hlth Med 1999;21:22-28 Competing interests: None declared |
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