Primary care teams had to adapt service delivery models rapidly after the onset of Covid-19, not least in response to a significant increase in deaths in the community. In the first months of the pandemic, deaths in care homes rose by 220% and deaths at home by 77%, while hospice deaths fell by 20%.1 This underlines the rise in workload burden on primary care.
Mitchell and colleagues (2021) conducted a study2 to seek the views of GPs and community nurses providing end-of-life care during the first wave, in order to inform future service planning and delivery. A questionnaire during September and October 2020 received 559 responses (387 community nurses, 156 GPs and 16 unspecified roles) from across the UK.
The results revealed GPs and community nurses both witnessed a significant increase in the need to provide end-of-life care. Nurses took on greater responsibility in most care areas, including support to family members and symptom control; GPs said they had seen an increase in advance care planning. Both groups found their working hours altered in response to rising demand for end-of-life care at home.
Changes to service delivery, such as the mandated move to virtual consultations, led to a disconnect between GPs and community nurses and wider teams. GPs reported that consulting remotely limited the end-of-life care they could offer, while community nurses perceived that services such as general practice and specialist palliative care had withdrawn, leaving them to manage rising demand. Both groups experienced a significant emotional toll, with fears related to uncertainty and diminished colleague support.
The authors concluded primary care met an increased need for end-of-life care, at the cost of a considerable emotional impact on community nurses and GPs. They said this needed to be addressed, alongside the rebuilding of trust in teams. The study’s relatively low response rate from GPs was seen as a potential limitation.
Lucille Kelsall-Knight is a lecturer in children’s nursing at University of Birmingham School of Nursing
References
1 Bone A et al. Changing patterns of mortality during the Covid-19 pandemic. Palliat Med 34(9):1193–1201. bit.ly/3cGj41S
2 Mitchell S et al. Community end-of-life care during the Covid-19 pandemic. BJGP Open 2021; 5(4):BJGPO.2021.0095. bit.ly/3cEeQrP
