Developing end of life care provision in the community

Primary Care is central to the provision of End of Life Care (EOLC). Most of the last year of life is spent at home under the care of General Practitioners (GPs) and Community Nurses (CNs). Nationally, 19% of deaths occur at home and 18% in care homes, under the care of GPs and CNs. Local and national strategies emphasise the importance of increasing EOLC provision at home: the involvement of GPs and CNs in the care of patients approaching the EOL is set to increase over the coming years. However, medical and nursing student training in EOLC is limited. This leaves many clinicians feeling unprepared when providing care for people near the end of their lives and that they lack the training and knowledge required to deliver high quality EOLC. Previous studies have investigated the education and knowledge of GPs, while CNs have been little studied in this regard.

This study investigated the knowledge and prescribing habits of Peterborough and Cambridgeshire GPs and CNs to identify training and educational needs. It also gathered information on their views on the out of hours services in their area and their preferences for further EOLC education.


A questionnaire study of all General Practitioners and Community Nurses in Cambridgeshire and Peterborough, investigating their training and knowledge in key areas of Palliative Care.  Questionnaires were sent out to all General Practitioners and Community Nurses in Cambridgeshire and Peterborough.  Expert panels of doctors and nurses were asked to comment on the importance of the questions asked and the correctness of the answers received.


Generally a high level of knowledge was found amongst responders, with key areas for improvement identified. These include: educational needs and awareness of side effects of some medicines; specific training and practice to increase competency; and the need to increase awareness of night and evening services for end of life patients.

Presentations have been requested by different groups (community nurses, Peterborough Out of Hours service and local palliative care teams) to inform them of the results and facilitate discussion. In addition, data from this survey are informing several educational initiatives with which the CLAHRC team is associated, in particular the HIEC initiative. This study has been published in the Journal of Pain and Symptom Management.


Our partners include NHS Cambridgeshire and NHS Peterborough. Both of these Primary Care Trusts are using the information from the study to help tailor the content of training courses for health practitioners.

For more information contact: Dr Stephen Barclay, Department of Public Health and Primary Care, University of Cambridge,



Momen N, Hadfield P, Harrison K, Barclay S. (2012) “Managing pain in advanced cancer: a survey of United Kingdom General Practitioners and Community Nurses”. Journal of Pain and Symptom Management: November 2012 e-published in advance

Project report – Momen N, Harrison K, Hadfield P, Fyfe M, Barclay S, General Practitioner and Community Nurse symptom management in End of Life Care: a questionnaire study in Cambridgeshire and Peterborough PCTs,  2011.