More support needed for GPs delivering palliative care

Morgan Liotta

17/05/2024 11:48:58 AM

GPs are being asked to share the challenges and successes of providing palliative care, which experts say can be part of day-to-day consulting.

GP with palliative care patient
‘GPs are perfectly placed to identify and recognise deteriorating patients and struggling families’, says a palliative care GP expert.

With the right supports and education, palliative care can be part of GPs’ routine, according to experts. But challenges lie in providing that care.
For Melbourne GP and palliative care provider Dr Pallavi Prathivadi, she believes this area of care is embedded in what GPs already provide.
‘Most of us who are generalists or working in a “cradle-to-grave” model of general practice are providing palliative care, whether we call it that or not,’ she told newsGP.
‘GPs are perfectly placed to identify and recognise deteriorating patients and struggling families.
‘We should be referring to palliative care units early – and often if we expect the patient to die within the next 12 months, or at diagnosis of significant progressive illness – and discussing plans for palliative care, advanced care planning and end-of-life care with most patients with chronic disease much earlier than we do.’
A key barrier for GPs delivering palliative care is a lack of funding, according to Dr Prathivadi, especially for care that requires after-hours and urgent work which she says can be ‘emotionally draining’.
‘Without well-funded palliative-care specific MBS item numbers, there is a huge lack of incentivisation to provide dedicated care that often requires home visits, long appointments, family meetings and support, and driving sometimes quite significant distances,’ she said.
‘It is also quite morally confronting to charge out-of-pocket costs or privately bill a patient who is dying, so many of us are routinely under-billing palliative care appointments and almost providing it as a “voluntary service” because of personal drive or passion.
‘This isn’t a sustainable business model though, and carries high risk of burnout and threat to the GP workforce.’
Other barriers Dr Prathivadi cites include time pressures, fear of providing the ‘wrong treatment’, or fearing lack of specialist support or expertise.
To mark National Palliative Care Week, which runs 19–25 May, Palliative Care Australia (PCA) has launched a survey seeking to identify the challenges, barriers, and successes in delivering or accessing palliative care in a range of health settings.
Targeted to those working in the specialist palliative care, aged care, primary health, and allied health sectors, the survey focuses on:

  • palliative care in primary and aged care settings
  • workforce pressures
  • after-hours care
  • voluntary assisted dying
  • experience using the National Palliative Care Standards.
CEO of PCA Camilla Rowland said the survey aims to collect specific feedback from GPs, given the key role they play when it comes to providing palliative care and engaging in conversations around death and dying.
‘We are especially keen for GPs to do this short survey so that primary health can grow and strengthen the cradle-to-grave service they provide to local communities,’ she said.
‘This survey is a critical step in making sure palliative care is at the heart of ongoing and future health reforms.’
Dr Prathivadi, who provides care to her patients through a local shared-care model with Eastern Palliative Care alongside palliative care nurses and physicians as part of a full clinical scope of general practice, believes palliative care can often be misunderstood in the community and even by doctors.
‘Some doctors, especially ones earlier in their career, can get intimidated by the concept of palliative care and feel it is outside our skillset,’ she said.
‘Upskilling and training in palliative care is easy, and well worth the impact of being the family doctor who stays with the family, actively, through the worst part of their lives. GPs are also expected by families to be competent and skilled in palliative care as part of the normal scope of general practice.
‘It’s not only end-of-life care, or where death is expected in days to weeks – it’s care for patients and families where the person has active, non-curable, advanced disease that will progress to death.
‘The care is about emotional, social and medical support to provide the highest quality of life that is possible. We are family doctors, we treat families. We will be here for the patient and family before they die, as they die, and well after they die.’
With a PhD in safe opioid prescribing, Dr Prathivadi’s interests are opioid policies and helping to reduce non-evidence based prescribing such as for chronic non-cancer pain, but also ensuring access to these medications for palliative care and pain management – which she says are both ‘all about quality of life’.
She says opioid policy needs to consider ‘there is always a time and place for these drugs’ in healthcare spaces of palliative care and chronic pain.
‘GPs are perfectly placed to help deliver essential palliative care and pain management,’ she said.
‘We work well in shared-care models and know patients and families the best … they want and expect GPs to be involved in their palliative care.’
Ahead of National Palliative Care Week, Dr Prathivadi offers ‘strong advice and a genuine request’ to better support GPs’ delivery of palliative care services.
‘It’s to advocate for and secure well-funded MBS item numbers … with consideration of travel time, after-hours work, home-visits and biopsychosocial complexity,’ she said.
‘Perhaps like with mental health treatment plans, higher rebates could be accessed after formal training, easily delivered by the RACGP or Primary Health Networks.’
Palliative Care Australia’s ‘Survey of the National Palliative Care Workforce Across Health and Aged Care Settings’ can be completed by anyone who works or volunteers in any service that provides palliative care in Australia. 
DISCLAIMER: The RACGP does not support new disease/condition focused MBS items. For more information, see the college’s position statement on this topic.

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