Role and response of primary healthcare services in community end-of-life care during COVID-19: Qualitative study and recommendations for primary palliative care delivery.

Abstract

The need for end-of-life care in the community increased significantly during the COVID-19 pandemic. Primary care services, including general practitioners and community nurses, had a critical role in providing such care, rapidly changing their working practices to meet demand. Little is known about primary care responses to a major change in place of care towards the end of life, or the implications for future end-of-life care services. To gather general practitioner and community nurse perspectives on factors that facilitated community end-of-life care during the COVID-19 pandemic, and to use this to develop recommendations to improve future delivery of end-of-life care. Qualitative interview study with thematic analysis, followed by refinement of themes and recommendations in consultation with an expert advisory group. General practitioners (<i>n</i> = 8) and community nurses (<i>n</i> = 17) working in primary care in the UK. General practitioner and community nurse perspectives on factors critical to sustaining community end-of-life care were identified under three themes: (1) <i>partnership working</i> is key, (2) <i>care planning</i> for end-of-life needs improvement, and (3) importance of the <i>physical presence</i> of primary care professionals. Drawing on participants' experiences and behaviour change theory, recommendations are proposed to improve end-of-life care in primary care. To sustain and embed positive change, an increased policy focus on primary care in end-of-life care is required. Targeted interventions developed during COVID-19, including online team meetings and education, new prescribing systems and unified guidance, could increase capacity and capability of the primary care workforce to deliver community end-of-life care.