Background Most palliative and end of life care (PEOLC) is provided in primary care with referral to specialist palliative care (SPC) services for patients with more complex problems. Collaboration between general practitioners (GPs) and hospices is essential to deliver patient-centred PEOLC. There is little in-depth research on the collaboration between general practice and hospice services and the variety of models and processes that currently exist.
Aims To investigate GP experiences and perceptions of hospice care and the facilitators and limitations to SPC referral and shared care management.
Method A GP interview study across a CCG. Semi-structured interviews were performed and a framework methodology employed.
Results Twelve GPs participated. They described how use of hospice services is influenced by their own experience; practice expertise; perceptions of patients’ needs; and relationships with the hospice. Key themes were GP factors; perceived accessibility and responsiveness of hospice services; patient and family factors, which affect referral decision-making; and effective professional relationships. GPs viewed urgent referrals or referrals for patients from ethnic minorities as most challenging. They also struggled to identify the right time to refer patients with non-malignant diagnoses. GPs uniformly preferred personal communication with clinical nurse specialists and relied on stable professional relationships suggesting that care was disrupted when CNS cover was lacking.
Conclusions This study gives weight to the challenge of partnership working across teams of different palliative care professionals, and illustrates how professional relationships are central to effective collaboration, referral and patient management. We recommend further research into robust collaborative working and an evaluation of equity of access to services particularly for ethnic minorities. We also suggest the need for further development of contemporaneous electronic patient notes and GP education. These with stable service delivery are vital to planning future models of care and proactive service delivery.
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