“If a person is dying, you shouldn’t have to rush through having difficult conversations with them”
GPs say a lack of time to spend with patients is a key challenge they face when caring for people with a terminal illness, according to a survey published today.
Dr Susanna Hill, who took part in the survey, shares her experience as a practicing GP for over 29 years in North Devon.
“As GPs, we’re a familiar point of contact for our patients, from the point of the diagnosis of their terminal illness right until the end. That’s why caring for someone at the end of their life is such a fundamental part of our role as GPs. In my practice, I’ve known a number of my patients as long as 20 to 30 years, so giving the very best care that you possibly can is something you want to do for them and their families.
“But this vital relationship we have with our patients is getting squeezed. It’s enormously sad to hear from colleagues in primary care that we all struggle to give patients who are terminally ill and their families the time and support they need from us.
The struggle with time
“There are many reasons why we’re finding it more and more difficult to give people the time they need. Changing demographics, where our ageing population is growing each year, mean that we have more patients with more health needs. Through new medical improvements, treatment options have also steadily increased in recent years, with people expecting more interventions than ever before to help them manage their health problems.
“Across the UK, there’s a move towards caring for more people in community settings. This is especially important if we want to be able to fulfil people’s wishes at the end of their life – it usually means being cared for, and dying, in their own home. It also relieves pressure on hospitals. But to do this properly clearly requires more time from healthcare professionals in the community, like GPs.
“All of these factors, alongside a chronic shortage of GPs and community nurses, and an increasingly disjointed way of delivering healthcare services, have meant that many GPs are now struggling to spend the time needed to provide the high quality care they want to give their patients.
Time to have difficult conversations
“I know from my experience that it takes knowledge and resources, especially time, to deliver good end of life care.
“Ideally, when one of my patients is approaching the end of their life, I’d like to visit them in their home every day. But in the past few years, I’ve found it more difficult to do regular home visits to see patients who are terminally ill. There’s the constant compromise between doing what’s best for our patients and the limited resources we have, including time and nurses working in the community.
“If a person is dying, you shouldn’t have to rush through having difficult conversations with them and their families. Although you certainly need good communication skills to have these conversations, which are never easy no matter how many times you’ve done them before, you also need the time to do them well.
“There are occasions when you wish you could spend another 10 or 20 minutes with your patient, but when you’re running a busy practice, that’s often not possible.
Time to give and co-ordinate the right support
“As GPs, it’s our role to spend time talking to our patients, find out what their needs are, and make sure everything is in the right place.
“You want to be able to discuss their wishes about how and where they want to be cared for when the end approaches, and involve their families in these conversations.
“Getting the care plan together, planning ahead with other community teams including nurses and the out-of-hours and emergency services, organising ‘just in case’ medications, and completing all the necessary paperwork are some of the things we need to consider to make sure all the elements of the patient’s care package are there.
“It’s a team effort to co-ordinate care and support for a patient and their family, and to do this well, we need time.”
Dr Susanna Hill’s experience is reflective of the UK-wide Royal College of General Practitioners and Marie Curie survey where the majority of GPs (83%) said giving more time to patients is a top priority for improving end of life care.
While 71% of GPs said that consultation time for patients with a terminal illness should ideally be over 20 minutes long, 86% said their routine appointment time was 20 minutes or less, of which nearly half (46%) were only able to offer 10 minutes or less.