Submitted by James Cantwell on Fri, 28/03/2025 - 11:34
Researchers from the University of Cambridge have found that community nurses providing palliative care find collaborating with GPs harder, where practices have moved towards remote communication and workforce diversification.
The study, published in the British Journal of General Practice, explores how reshaping collaboration between GPs and community nurses is having mixed implications for palliative care.
During the study, researchers engaged with community nurses who described how they are increasingly extending their roles, taking more responsibility for person-centred care including complex symptom control decisions and having ‘difficult’ conversations.
Discussing the effects of the care delivery, Dr Ben Bowers, Wellcome Post-Doctoral Research Fellow, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge:
“Task-shifting is an approach often adopted in policy and practice when a professional group experiences increasing workloads, and chronic recruitment and retention difficulties. However, task-shifting from GPs has mixed impacts on community nurses, especially when they are taking on increased responsibility for having sensitive, open conversations about dying and exploring care preferences. Complex decision-making has shifted from GPs to community nurses without suitable support being built in, such as having easy access to senior medical advice and input when needed. When planning and evaluating changes in ways of working in general practice, our findings highlight the importance of considering the consequences of these changes across the whole ecosystem of community care provision.”
Watch our video with Dr Bowers to learn more.
Challenges in GP-Community Nurse Collaboration
While expanding the scope of their responsibilities can allows community nurses to provide more comprehensive care, the study found that managing complex medical care still requires timely GP input. However, accessing this support has become more difficult under the new working model. There are other areas that appear to contribute to this challenge, such as practices that rely on a diverse workforce to manage GP workloads, by involving other clinicians such as GP-based paramedics and advanced practitioners.
The challenges in ways of working do not represent a devaluing of the importance of providing end-of-life care in general practice. Rather, they reflect the increasing demands on GPs, which have influenced decisions to pivot the delivery of care towards the most effective and pragmatic methods available. These changes aim to manage workloads and ensure that patients continue to receive high-quality care, even as the healthcare landscape evolves.
Expanding the role of paramedics
With the changes to GP’s new ways of working, the study identified the expanding role of paramedics in conducting GPs’ home visits. While some participants noted that paramedics were seen as excelling in specific tasks, many nurses felt their input was not an adequate substitute for GP support in complex cases. This highlights the importance of trust and clear role boundaries between professional groups to ensure effective collaboration.
Growing Need for Community Palliative Care
The study also underscores the rising demand for community-based palliative care. As the number of people dying at home increases and hospitals discharge patients with more complex end-of-life care needs (Couchman et al, 2024), the strain on community services is intensifying. Community nurses, working in tandem with GPs, are at the forefront of meeting this demand. Strengthening these collaborative relationships and ensuring integrated care delivery will be essential to address the challenges posed by these demographic and healthcare system trends.
Dr Bowers added:
“More people are dying at home with increasingly complex end-of-life care needs. Community nurses, supported by GPs, are the key clinical providers of this vital care. Our study findings highlight that we need to review how care providers can best work together to provide high-quality care, in an increasingly resource-constrained environment.”
Implications for General Practice
The findings of this study emphasise the need for general practices to consider the wider consequences of their evolving ways of working—not just within primary care teams and for their patients, but across the entire ecosystem of community care. Rebuilding better working relationships between GPs and community nurses and ensuring more integrated care will be vital to supporting both the workforce and the patients and families who depend on them.
This study offers valuable insights into the ripple effects of changes in general practice on wider community care provision, highlighting the need for thoughtful planning and evaluation to support healthcare professionals and improve outcomes for patients.
References:
Couchman, E. et al. (2024) 'Reforming primary palliative care: a call to arms,' British Journal
of General Practice, 74(738), pp. 4–6. https://doi.org/10.3399/bjgp24x735861.