I was reflecting on the 3 years since I retired. In my own region there are numerous practices who cannot recruit new doctors. There are practice teams falling apart, and there are nearly 10% of practices under “special measures” which means they need to be managed by the local Trust and manned by expensive locums. The undercapacity issue is now driving those who started with altruism into systems where there is a disincentive to make a claim, and where performance management is less intrusive. I hope there is someone willing to write the obituary for UK General Practice..
General Practitioner partners much younger than myself are emigrating, retiring, or simply moving to locum work, without long term commitment. Some of the best and most experienced have gone, and more will follow..
Francis Elliott in the Times on 29th July 2014 reports: Right to die at home register ‘would save cash’ and five years ago Britain was ranked first on Quality of Death
On 26th June Public Health England released a report and commented: End of life care improving according to report. The ‘What We Know Now 2014’ report suggests a growing understanding within the health sector of what is important to people at the end of life. The percentage of people dying at home increased from 35% to 44%, and the report says:
“The factors most important to people at the end of their life are having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignity. ” (Continuity of care must come closely after these). 28% of people would choose a Hospice, if it is available, and often to protect their relatives. Continuous GP care is needed more in rural locations without easy access to Hospice or with Hospice at Home.
The Times 26th June 2015 (absent from website) reports “More patients are allowed to die at home” and the headline reveals the gradual loss of autonomy for most of us as we approach death. Advanced directives can help, but there is nothing to replace open discussion between family and regular GP. Why should I need permission to die at home?