Intended for healthcare professionals

Letters If I Ruled the NHS

Improving access to specialist palliative care

BMJ 2015; 350 doi: (Published 24 February 2015) Cite this as: BMJ 2015;350:h1012
  1. Sébastien Moine, general practitioner and PhD student1
  1. 1Multi-professional Primary Health Care Center “The Vines of the Abbey”, 60130 Saint Just en Chaussée, France
  1. sebastien.moine.75{at}

The massive cultural shift that Lakhani calls for has to occur at various levels in health systems.1 In France, for example, after several national strategies to develop palliative care (lastly in 2008-12), access to specialist palliative care remains poor.

A recent report by the French Court of Audit highlights that access to palliative care remains generally limited; the development of graduated care provision in hospitals failed to reduce regional inequalities; and palliative care outside of hospitals lacks support and is insufficient, whether at home or in nursing homes.2

Until now, solutions to the problem of palliative care in France have come from within hospitals, and the central role of primary care has been neglected. Thus, the report’s conclusions are a vivid example of what it entails to respond to massively widespread needs with scarce resources.

Furthermore, one of the major challenges that Lakhani points out is the urgent need for health professionals to work as genuine “unified teams,” especially in the community. In France, the method of payment for primary care professionals (fee for service) is a serious barrier to multi-professional teamwork if new forms of remuneration that promote coordination and collaboration are not used more widely.

At a time where the strengthening of palliative care as a core component of health systems has been identified as a major goal globally,3 these facts must be urgently taken into account to adapt service provision to the needs of the people.


Cite this as: BMJ 2015;350:h1012



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