Less than half of GPs believe the majority of their patients’ pain is relieved all the time
Terminally ill people are not getting access to the right care when they need it, according to a new survey commissioned by Marie Curie with Doctors.net.uk1. The survey, which reflects the views of 1,000 GPs across the UK, also reveals family doctors’ concerns about supporting patients being cared for at home.
GPs were also asked to indicate factors that are likely to reduce quality of pain control. Three out of five GPs (59%) opted for lack of anticipatory* (just in case) prescribing, over half (53%) expressed concern about over prescribing medication; while 39% considered poor availability of pain relief out of hours a determining factor.
The issue surrounding around the clock care was also highlighted in a new report published by Marie Curie today, called ‘Difficult Conversations with Dying People and their Families’2. Families reported having to chase after prescriptions, nurses waiting hours for vital drugs to arrive, and locums unable to prescribe.
“Of those GPs who do not feel patients get adequate access to pain control at home, over eight in 10 GPs rated access to 24/7 specialist palliative care rapid response teams** as a key answer to improving this.
Imelda Redmond CBE, Director of Policy & Public Affairs at Marie Curie, said: “Everyone is telling us – from GPs, families and carers – that more needs to be done to improve access to specialist palliative care and pain control at home.
“We know that effective pain management at home is an important factor that influences whether someone has a 'good death', and we only have one chance to get it right.
“Terminally ill people and their families need timely access to care and pain relief around the clock. At the moment two thirds of this time is considered to be ‘out of hours’ by the healthcare system. With only 17% of terminally people at home having their pain relieved completely3, it is vital that healthcare professionals are available to terminally ill people around the clock and that they are equipped to provide pain relief.
Dr Bill Noble, Medical Director of Marie Curie who is a former GP and past President of the Association for Palliative Medicine, said: “GPs are best placed to ensure effective co-ordination of palliative care. If their patients are to get the care they need to be at home in their terminal illness, NHS, social services and voluntary sector professionals all have their part to play.
“Our ageing population has increasingly complex and diverse needs, so it’s important that we equip and support GPs in their work. Our partnership work with the Royal College of General Practitioners*** is one way we are tackling this, but much more is needed.”
Imelda Redmond added: “Terminally ill people should not be spending their last precious weeks and days with the families in unnecessary pain because the system moves too slowly. This is why we are calling on clinical commissioning groups to do more to ensure that 24/7 care is universally accessible for all terminally ill people and their families, no matter where they live in the country.
1. The survey was commissioned by Marie Curie with Doctors.net.uk (DNUK) and conducted by DNUK’s research division medeConnect Healthcare Insight. Respondents were recruited from the Doctors.net.uk membership. Responses were collected from 1003 regionally representative GPs in the UK. The survey fieldwork was conducted over the period 22-28 January 2014.↩
2. ‘Difficult Conversations with Dying People and their Families’- Report, March 2014↩
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Notes to Editor
* Anticipatory (just in case) prescribing is designed to enable prompt symptom relief at whatever time the patient develops distressing symptoms, and is based on the premise that although each patient is an individual with individual needs many acute events during the palliative period can be predicted and management measures put in place in advance.
** Rapid response teams provide urgent palliative care support to patients in the community, to manage care and prevent unnecessary hospital admissions. They are available 24/7, all year round, allowing terminally ill people to access the right care, when and where they need it.
***Marie Curie and Royal College of General Practice End of Life Care partnership. Further details available: Royal College of General Practitioners.
Marie Curie is the leading charity providing care to people with any terminal illness in their own homes or in one of its nine hospices. The charity is also a leader in research into the best ways of caring for people with a terminal illness. In addition to this the charity designs and advises on end of life services and works to ensure that the best possible care and patient choice is at the heart of commissioning end of life care across the UK. All Marie Curie services are completely free of charge. Around 70% of the charity’s income comes from donations with the balance of funds coming from the NHS.