Abstract
BackgroundSpecialist palliative care is being increasingly recognised and developed to improve end-of-life care in many developed countries. However, only a small proportion of the total number of patients with incurable, progressive diseases actually has direct contact with specialist palliative care practitioners. Using the German situation as an example, the main purpose of this paper is to argue that the emphasis on specialist palliative care services without a similar encouragement of primary palliative care will deliver a constrained service.DiscussionFor the vast majority of people with incurable, progressive diseases, good palliative care delivered by General Practitioners and community nurses, with access to specialist support when needed, is the optimal response. In Germany, specialist palliative care in the community was established in the 2007 health care reforms. However actual and potential delivery of palliative care by general practitioners and community based nurses has been sorely neglected. The time-consuming care of palliative patients and their families is currently far from accurately reflected in German, indeed most European primary care payment systems. However, it is not just a question of adequate financial compensation but also of the recognition of the fundamental value of this intense form of holistic family medicine.SummaryIt is imperative palliative care carried out by community nurses and general practitioners is better recognised by health professionals, health insurers, government and the scientific community as a central part of the delivery of health care for people in the last phase of life. Health systems should be arranged so that this critical role of general practice and primary care is intentionally fostered. Palliative care carried out by generalists needs an identity at an academic and practical level, developing in concert with specialist palliative care.
Highlights
Specialist palliative care is being increasingly recognised and developed to improve end-of-life care in many developed countries
Summary: It is imperative palliative care carried out by community nurses and general practitioners is better recognised by health professionals, health insurers, government and the scientific community as a central part of the delivery of health care for people in the last phase of life
In Germany, for example, in order to enable more people to spend the last phase of their lives at home, avoid unnecessary hospital admissions and improve patients’ quality of life, legislators established specialist palliative care in the community as part of the 2007 health care reforms (§ 37b of German Social Security Code V), with varying degrees of specialist support, ranging from one-off consultations to full palliative care provided by a specialist team
Summary
Specialist palliative care is being increasingly recognised and developed to improve end-of-life care in many developed countries. In Germany, for example, in order to enable more people to spend the last phase of their lives at home, avoid unnecessary hospital admissions and improve patients’ quality of life, legislators established specialist palliative care in the community (spezialisierte ambulante Palliativversorgung, SAPV) as part of the 2007 health care reforms (§ 37b of German Social Security Code V), with varying degrees of specialist support, ranging from one-off consultations to full palliative care provided by a specialist team. The movement to implementation is in practice sluggish, and is complicated by unanswered questions regarding requirements, content and structural design, and by problems in quality assurance and resource distribution These implementation problems should not detract from the promising potential SAPV has in bringing about sustainable improvement through innovative approaches to caring for the seriously and terminally ill. The introduction of SAPV is in line with the international trend towards specialist palliative care services for patients with high care needs [1,2]
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