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Dying at home during covid-19: a view from primary care

Editorial, 19 June Higginson and colleagues highlight the need for high quality, community end-of-life care as a significant ongoing concern for the NHS.1 The role of primary care in end-of-life care needs much more attention, as reported by The BMJ over the past two decades.2 3 Primary care has had a key role in the delivery of end-of-life care to patients dying at home during the covid-19 pandemic, adapting rapidly to meet increased need. Clinicians and managers from primary care and specialist palliative care have worked collaboratively to identify concerns and find timely solutions.District nurses, alongside carehome staff, have delivered most of the face-to-face end-of-life care in the community. They report feelings of isolation, however, as other services increased remote consultations.4 Reducing face-to-face contactwithdyingpatients causedmoral distress for general practitioners.4 Primary care servicesmanagedpatientswith increasingly complex needs and saw a large number of rapid deaths, particularly in care homes. For many patient facing communityprofessionals, therehasbeena significant emotional impact.4 Higginson and colleagues highlight the lack of systematic evidence to understand the quality of end-of-life care delivery during covid-19. The role of primary care in end-of-life care is vital but has received little attention in policy, or funded research, during this and previous pandemics.5 Emerging evidence from this pandemic is, to date, focused mainly on the response of specialist palliative care.6 -8 Naturally, this important research informs renewed calls for funding for palliative care services. As healthcare services move through the next phases of the pandemic without new funding, more community focused, collaborative approaches are needed. Specialist and generalist professionals are united in their desire to tackle longstanding inequities in access to palliative and end-of-life care. Frontline primary care has the potential to deliver high quality community end-of-life care for all who need it.9