Intended for healthcare professionals

Letters Primary palliative care

Identifying those in need of specialist palliative care

BMJ 2019; 365 doi: (Published 11 June 2019) Cite this as: BMJ 2019;365:l4115
  1. Andrew Thorns, consultant in palliative medicine
  1. Pilgrims Hospice, Margate CT9 4DA, UK
  1. athorns{at}

Mitchell and colleagues describe the importance of primary and specialist palliative care working together.1 That specialist services are “neither needed nor wanted” by some patients is true, but the challenge is in identifying the need, especially when not immediately obvious.

We have long established evidence and systems to identify high risk pregnancies. Primary care is very adept at recognising early the mother and baby that are likely to run into difficulty and referring them for specialist input.

We need more research into identifying the “high risk death” early so the right people and their families can benefit from the right help at the right time.


  • Competing interests: None declared.