All future GPs should have palliative care experience, says GP trainee

Future GPs should develop palliative care experience as part of their training, according to a GP trainee working in a London hospice before taking up a registrar post later this year.

Dr Abhijit Gill at the Royal Trinity Hospice, London
Dr Abhijit Gill at the Royal Trinity Hospice, London

GP trainee Dr Abhijit Gill is among six newly qualified doctors working in the inpatient unit at south London's Royal Trinity Hospice as part of a scheme launched this year.

The hospice developed the scheme to address its concerns that many doctors complete training with little experience of how to speak to terminally ill patients. It hopes to help young doctors 'develop the crucial communication skills around difficult conversations which will inevitably be required throughout their career'.

End-of-life or palliative care training looks set to become increasingly important for GPs, with the general population ageing fast and patients increasingly expressing a wish to die at home.

End-of-life care

Meanwhile, the CQC announced last month that it planned to incorporate the quality of end-of-life care offered by GP practices into its ratings system.

Dr Gill told GPonline that only with experience could doctors become at ease talking to patients and their relatives about issues to do with death and dying.

The importance of end-of-life care knowledge was driven home to him during a spell working nights as an SHO in a hospital acute unit, he said. 'The daughter of a patient known to be terminally ill came up and asked me about death and dying.

'To be frank, I was struggling to use words like "death" and "dying". I hadn’t had those conversations. But now I would be comfortable addressing those issues head on.'

During his ST1 job in general practice, Dr Gill said the practice he worked at was keen for trainees to have experience of palliative care, and linked each trainee to a patient with whom they were in contact regularly.

GP training

But he said many trainees would not have had that experience, and warned: 'Even that isn't enough. Doing the hospice job has made me realise how varied and multifaceted palliative care is - with different aspects like referrals, prescribing, psychosocial support - and how much it improves your communication skills.

'It is really, really important for all doctors, regardless of specialty, to have some exposure to palliative care whether in a community or hospice setting. Every doctor has to break bad news.'

For GPs, he felt palliative care experience during training should be a requirement. 'For GP trainees there should be some mandatory element of end-of-life care. GPs are going to be seeing this more in the community with changing demographics and more people wanting to die at home, so if a GP has this experience in training, it is golden.'

The Royal Trinity Hospice, founded in 1891, is England's oldest hospice. The charity provides free care and support for people with 'progressive, life-limiting illnesses' and their families, and education for health and social care staff. It receives around a third of its annual income from the NHS, and relies on donations to raise a further £8m a year to cover its costs.

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