Published: 07/04/2005, Volume II5, No. 5949 Page 33

King's Fund calls for consistency on palliative care

Primary care trusts need more support to provide day-to-day care for the terminally ill, according to Palliative Care: perspectives on caring for dying people in London, by the King's Fund.

The report is the result of two years' research into a service that varies widely in its organisation. The report suggests that care also suffers from the differing perspectives of GPs, district nurses and community nurses - the three key service providers.

The King's Fund says there are significant differences in approach between PCTs.

The number of specialist voluntary sector and acute trustbased providers operating in a PCT varies widely, as do the number of host organisations of specialist palliative home care teams.

There are also differences in approach.

Some palliative care systems involve few organisations while others are far more complex, making effective communication crucial to overcome conflicting priorities.

Almost three-quarters of the GPs surveyed for the report agreed or strongly agreed that palliative care is a central part of their role. The fact that one in four did not means that the extent of primary care offered varies substantially.

District and community nurses felt that some GPs were peripheral, with little daily involvement, a lack of specialist knowledge and a focus mainly on prescribing.

District nurses felt they played a pivotal role as co-ordinators of palliative care and the professionals most in contact with patients, a view shared by the other professionals.

Community nurses saw themselves as advisers to the primary care team and patients.

The report recommends strong communication and good relationships to help services work together.

But responsibilities also need to be clarified. It suggests that PCTs develop a framework for general provision of palliative services or consider alternatives such as GPs with special interests or extending the role of specialist services.

www. kingsfund. org. uk

The National Primary Care Research and Development Centre and the primary care group of Swansea University's clinical school have developed a prototype website for patients to access information about their general practice.

YourGuidetoGeneral Practice. org. uk is part of a three-year project that began in 2002. It works with four PCTs and 24 practices to look at what data on quality of care can be provided and how it could help patients be more involved in health delivery.

As well as explaining how practices fit in with the rest of the NHS, who their GPs are and what services are provided by the surgery, the website also includes quality indicators.

www. npcrdc. man. ac. uk