Community palliative medicine out-of-hours needs and the 7-day week: a service evaluation

Abstract

BackgroundEvidence regarding out-of-hours (OOH) community palliative care provision is required to inform the need for a 7-day work.AimThis paper seeks to provide evidence for this discussion by defining general practitioners’ (GPs) OOH workload and patients’ demographics, symptomology and interventions. By quantifying the challenges faced, we can understand current practice and focus on what provision is required.DesignUsing Shropshire Doctors Co-operative’s recorded data, the authors have collated a representative picture of the OOH GP palliative care practice over a year from 161 OOH GP–patient interactions.SettingPrimary care.ResultsPalliative care makes up 11.4% of the total OOH GP home visits (HV). Overall 56% of OOH GP HVs are for patients who are expected to die within 48 hours, with 80% of the symptoms being agitation, secretions and pain. Overall 5.7% of OOH GP palliative HVs resulted in hospital admission; however, this decreased to 0.6% adjusting for the last 48-hour prognosis.ConclusionOOH Shropshire GPs deal with a wide variety of scenarios in a heterogeneous population. The greatest demand is from 17:00 to 00:00 (65% of the total shift) on weekdays, and from 09:00 to 00:00 on weekends (82% of the shift). These data begin to quantify the role being performed by OOH GPs, have implications for service provision and support 7-day work.