About one quarter of GPs surveyed are not involved in palliative care. Strategies to increase GPs' involvement should aim at increasing their knowledge and interest in palliative care. Innovations in service provider models are required to overcome the barriers to provision of after-hours care.

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD). Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009. Intervention: Participants from intervention group practices were visited at their home by a registered nurse with specific training in COPD care who worked with the general practitioner, the patient and other health professionals to develop and implement an individualised care plan based on best-practice guidelines. Participants from control group practices received usual care. Main outcome measures: The primary outcome was disease-related quality of life measured using the St George's Respiratory Questionnaire (SGRQ) at 12-month follow-up. Other outcomes were overall quality of life, lung function, smoking status, immunisation status, patient knowledge of COPD, and health service use. Results: Of the 451 participants, 257 (57.8%) were confirmed as having COPD on postbronchodilator spirometry. Follow-up was completed for 330 patients (73.2%). At 12 months, there was no statistically significant difference in the mean SGRQ scores between intervention and control groups (38.7 v 37.6; difference, 1.1; 95% CI, -1.53-3.74; P =0.41) or in measures of quality of life, lung function and smoking status. Compared with the control group, in the intervention group, attendance at pulmonary rehabilitation was more frequent (31.1% v 9.6%; OR, 5.16; 95% CI, 2.40-11.10; P =0.002) and the mean COPD knowledge score was higher (10.5 v 9.8; difference, 0.70; CI, 0.10-1.21; P=0.02). Conclusion: The nurse-GP partnership intervention did not have an impact on disease-related quality of life at 12-month follow-up. However, there was evidence of improved quality of care, in particular, in attendance at pulmonary rehabilitation and patient knowledge of COPD. 1 Guidelines for care of COPD provide recommendations for slowing disease progression and optimising function in people with COPD.2,3 The key interventions are smoking cessation, pulmonary rehabilitation, influenza vaccination, optimising medicines, patient education and effective management of exacerbations.There is a need for effective approaches to implementation of evidence-based treatment in primary care, where many patients with COPD are managed. Nurses, either within the practice or visiting to provide specialised care, could have a role in improving management of COPD, including by helping to implement planned care.A review of nine randomised trials of nurse-led chronic disease management for COPD concluded that there was no evidence of improvements in patients' healthrelated quality of life, psychological wellbeing, disability or pulmonary function.4 A more recent Cochrane review of nine trials of outreach programs involving nurse home visits to COPD patients concluded that providing support and education, monito...

Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.