How do we support GPs providing end of life care?

by Dr Lucy SelmanDr Lucy Selman
Research Fellow (Qualitative Research in Randomised Trials)
Centre for Academic Primary Care

GPs are vital to the delivery of end of life care. They coordinate care, provide generalist palliative care, help prevent unnecessary hospital admissions, and, in England, commission local health and social care services. Crucially, they help shift care from hospitals to the community, which is where most people would prefer to die.

But providing good care at the end of life is not always straightforward. There’s evidence that GPs can find it challenging, and that the quality of end of life care by GPs can be problematic. The Royal College of General Practitioners and the House of Commons Health Committee therefore recognise the urgent need for evidence-based education in end of life care for GPs. However, the evidence base for GP training in end of life care is unclear, and no rigorous evaluations … Read more

Are some patients more equal than others? Looking back at the Cancer Drugs Fund

Padraig Dixonby Dr Padraig Dixon
Senior Research Associate
Centre for Academic Primary Care

Imagine being given £400m of taxpayers’ money to spend on drugs for the benefit of NHS cancer patients. How would you decide which therapies to fund? Would you decide that all cancer patients should benefit equally, or would you decide to spend more on particular types of cancer, or on particular types of patient?

These issues were confronted by the Cancer Drugs Fund (CDF), the 2014/15 expenditures of which were £416m (against a budget of £280m). The CDF was created to make available to patients in England cancer drugs not recommended by the National Institute of Health and Care Excellence (NICE) on the basis of cost-effectiveness, not yet appraised by NICE or which were being used outside market authorisations.

The effects of the CDF on population health are controversial: one estimate is that the CDF has caused five times … Read more

Dying in the UK? Lucky you.

Lesley Wye photoBy Lesley Wye
Senior Research Fellow
Centre for Academic Primary Care

My father is dying. This is pretty bad. What’s worse is that he’s dying in the US.

The Economist Intelligence Unit recently published a report that ranked the UK as the best place to die in the world, with the US ranking 9th, and I’m inclined to agree.

With advanced prostate cancer, a tumour in his liver 14 cm long, another pushing in his bladder and a recent bout of pneumonia, we’ve been told that my father has “weeks” to live.

He’s currently in a ‘skilled nursing facility’ on the premises of a retirement community. Medicare, a US federal government programme, is paying for his care, but only while he continues to have physiotherapy twice a day. It’s rather heart-breaking watching my father struggle to stand for more than 30 seconds and then collapse exhausted in his bed. But … Read more