Building bridges in palliative care: evaluating a GP Facilitator programme

Abstract

The objective of this study was to evaluate the impact of the Macmillan GP Facilitator Programme in Palliative Care on the knowledge, attitudes and confidence in symptom control of general practitioners (GPs), communication with patients and out-of-hours practice. GP Facilitators work on average for two sessions a week with practices in their locality. The design included a before and after study, with geographical controls matched on type of area (inner city, urban and rural) and broadly on Jarman scores using postal questionnaires sent to GPs. Scores measured change in GP awareness, attitudes and practice over two years of the intervention, derived from Likert scale responses to the postal questionnaires. Although overall few significant results were found, we did identify an increase in the use of palliative care guidelines in Facilitator districts, together with an increase in awareness of day care. The programme was associated with increased positive attitudes towards specialist palliative care services and results suggested increased satisfaction with out-of-hours services for patients. No change was found for confidence in symptom control and communication over diagnosis with cancer patients was less than in control districts. The design also incorporated a qualitative component, and from this we found the Facilitator programme to be popular with local GPs who valued the support of a colleague who knew the demands and constraints of general practice. In conclusion, we have demonstrated an impact of the GP Facilitator programme on GP awareness of, use and increased positive attitudes towards specialist palliative care services. By improving communication between primary and specialist palliative care, the programme should contribute substantially to improved care of the dying at home.

Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review

“…18 Enhanced partnership working also has significant positive impacts for health professionals, including empowering generalists, supporting staff in decision making, and increasing positive attitudes among generalists to specialist palliative care provision. 32 These findings are in line with other research that highlights a range of positive outcomes of multidisciplinary working in other areas of healthcare delivery. 38 …”

“…16,18,19,22,25,30 and five were evaluations of partnership working models. 23,26,27,29,32 Eleven of the papers used qualitative methods; 5,15,17,20,21,24,28,30,31,33,34 seven used quantitative methods; 19,22,23,25,27,29,35 three used mixed methods; 18,26,32 and one used a casestudy approach. 16 Some methodological weaknesses exist in the studies reviewed, so some caution must be exercised when attempting to draw any firm conclusions.…”

“…Achieving coordinated care and continuous support for patients was seen as challenging, and different models were proposed for ensuring continuity of care. 32 In one study, heart failure nurses took on the role as coordinating key workers for their patients with heart failure. The model was evaluated as both cost effective and sustainable.…”

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

“…How such information and education might be provided has been subject to debate, and the role of GP Facilitators in palliative care who provide a bridge between primary and specialist services has been positively evaluated. 22 Respondents rated almost all services as being important for future development, and mean scores were higher than those reported for other areas of England. 23 This reported need for development may reflect perceptions of lower availability or accessibility of services (particularly specialist services) within London; again, highlighting the need for good communication about services and their uptake.…”

How General Practitioners in Bulgaria Tackle Palliative Care?: A Cross-Sectional Study

“…13 The data obtained from the general practices studied concerning the patients in need of palliative care are comparable to those found in the literature -an average of 5.5 palliative patients/year in one general practice for Great Britain, 4-5 patients/year for Australia, with the GPs caring for a minimum of two of these patients independently in their homes. 11,14 A substantial shortcoming that makes difficult the application of the palliative care approach is the lack of established criteria and indicators for initiation of this type of care. 15 According to the respondents, a given diagnosis can be accepted as an indicator for palliative care, as well as the presence of certain symptoms, characterizing the severity of the condition.…”