Skip to 0 minutes and 8 secondsMy name is Lisa Linge-Dahl and I'm a researcher at the University of Bonn.

Skip to 0 minutes and 16 seconds[Why did you look at the role of the GP] Naturally, you would expect the GP to play a really important role in the care network of palliative care patients, and we did interviews with patients and thought it would be really interesting to look into the patient's point of view-- how they see the role of the GP in reality. We subdivided the role of the GP in four different fields. One is availability. The other is taking over a role-- a coordinative role. Then there's, of course, health-- medical treatment and also psychosocial support. So you would look at those four different aspects at the five countries and then analysing the interview data.

Skip to 1 minute and 6 seconds[Availability] Well, in general, the patients would say that their GP is available, but they would complain about different aspects of availability in different countries. In the UK, for example, patients would complain about having long waiting periods until getting an appointment at GP and then having to wait for a long time before being called in the office, which is a burden for palliative care patients because they are suffering from so many symptoms. And then they would have to wait there for a long time. In Germany, patients complained about their GP not doing home visits anymore after the onset of the specialist palliatives care team in which the GP used to do in advance, and it's just for palliative care patients.

Skip to 1 minute and 57 secondsIt's really nice of the member of the care network that the doctor comes to their home. In Hungary, we have a special situation because you don't have these specialist services who are available 24/7, so the GP has to remain in that role and take over the 24/7 availability. And patients would expect him to hand over his private phone number so they would have this availability. And if the GP wouldn't do it, then the patients would have periods of time where they just cannot reach somebody to call in case of emergency. And then they, of course, would have to go to hospital, which they might want to avoid.

Skip to 2 minutes and 47 seconds[Co-ordination] The coordination is really different in the countries of who is expected to take over the coordinative role. So, for example, in Belgium, the nursing services and the GP are expected to do the coordination of the care at the same time, which ends up in being a confusion and then maybe sometimes neither of them is taking over responsibility. And on the patient's side, the patient might just not be sure who to call, whom to contact with different kinds of situations, while for example, in Germany, the GP would maybe be expected to do the coordination, but in practice, it's by the onset of the specialist palliative care team, they take over the coordination.

Skip to 3 minutes and 45 secondsAnd this is perceived by the patients as working very well.

Skip to 3 minutes and 52 seconds[Medical treatment] You would divide medical treatment into a general medical treatment and specialist palliative care treatment. And mostly the GP would do the general medical treatment. Sometimes they would just go down to basically just doing referrals and writing prescriptions and the specialist palliative care treatment would be taken over by the palliative care team. And also from the patient's point of view, this is what the patients would expect. They don't expect their GP to do the palliative specialist care.

Skip to 4 minutes and 31 seconds[Pyschosocial support] While psychosocial support is being connected to the GP from the patient's point of view pretty strongly because they have a long history with their GP and they are most seen like a family doctor because they know all the health history. They know the personality of the patient and their preferences. They know the other family members. So patients would have extraordinary expectations towards their GP. And sometimes, this just cannot be met. And in all the countries, patients would complain about their GPs just not having enough time to listen completely and discuss things in detail that bother them or they are afraid about. And you would need other members of the care network to take care of it.

Skip to 5 minutes and 20 secondsSo basically this need for psychosocial support would be split up on different members of the care network except, for example, the palliative care specialist team-- but of course, also family caregivers or nursing services and would not be treated or covered completely by the GP.

Skip to 5 minutes and 45 seconds[Conclusions] While I would say that you cannot take for granted that the expectations we have on the GP's role in a palliative care-- integrated palliative care network, what we expect and you will always have different aspects that are just different in reality. And, for example, the situation we have in Hungary that there is a lack of a 24/7 availability shows that there's a need for a change in the situation. In other countries, you might just conclude that it's just different from what you expect and it depends.

Skip to 6 minutes and 27 secondsI think, in the end, it's really important that the patient's needs are met, and if it's being taken over by other members of the care network that will in the end result in a good situation for the patient, it doesn't have to be covered all by the GP.

The role of the general practitioner (GP)

GPs often play an important role in the care network of palliative care patients.

In the following film, Lisa Linge-Dahl focuses on findings from the InSuP-C project which relate to the role of the GP in integrated palliative care.

Lisa explores four key aspects of the role of the GP, as follows:

  • The availability of the GP
  • The GP’s role as the co-ordinator of care
  • The GP and medical treatment
  • The role of the GP in the patient’s psycho-social support

Did any of these findings surprise you or do they reflect your own experience?

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This video is from the free online course:

Palliative Care: Making it Work

Lancaster University