Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey.

Sarah Mitchell,Phillip Oliver,Dena Khan,Kirsty Boyd,Jeremy Dale,Helen Chapman,Catriona R Mayland,Stephen Barclay,Clare Gardiner

doi:10.3399/bjgpo.2021.0095

Abstract

BackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.AimTo understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.Design & settingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020.MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.ResultsValid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.

Highlights

The COVID-19 pandemic has caused primary healthcare services to dramatically change their traditional models of service delivery over a short timeframe
Primary healthcare services are playing a critical role in meeting increased need for end- of-life care in the community during the COVID-19 pandemic
This study provides insights into experiences of delivering end-o f-life care in the community during the first wave of the COVID-19 pandemic from the perspectives of UK GPs and community nurses

Summary

Introduction

The COVID-19 pandemic has caused primary healthcare services (general practice, and community nursing services including district nurses) to dramatically change their traditional models of service delivery over a short timeframe. While guidance documents for both general practice and community nurses outlined end-o f-life care as urgent priorities,[5,6] there were many new challenges in the delivery of that care, including the need for more remote consultations and the use of personal protective equipment. There were concerns about drug and equipment supplies and the need to manage new symptom profiles associated with COVID-19.7 Previous research and policy guidance for primary healthcare services in pandemics do not tend to refer to community end-of-life care, and there was little evidence to inform and guide the necessary service changes.[8,9]. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning

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