End of life care covers physical, emotional and social needs. It helps people approaching the end of their lives to live as well as possible in the time remaining.

Palliative care helps people with incurable health conditions to make the most of their lives, for as long as possible.

End-of-life care has always been an important part of the daily workload of GPs and other primary care professionals.

Of an average-sized list of around 2,000 patients, about 20 (one per cent) will be coming towards the end of their life. As people live longer and have much more complex health needs typical of the oldest old, managing the last few months of life has become more complicated, demanding more time and input from the multidisciplinary team.

A large number of these people need good palliative care, for example those who have a progressing malignancy, and this field continues to develop, although the removal of the Liverpool Care Pathway threw many people back (at least temporarily) towards the fumbling chaos that lead to its establishment in the first place. However, many others are not on a clear trajectory towards death but simply very frail with a high risk of complications that may prove rapidly fatal, or from which they may stagger on.

The value of advanced care planning (ACP) for these patients is increasingly recognised, but brings more challenges around trying to think ahead and consider what might happen and how to deal with it, as well as working with families and their expectations.

 FIVE PRIORITIES FOR THE CARE OF DYING PEOPLE

• The possibility that a person may die within the next few days or hours should be recognised and communicated clearly. Decisions should then be made and actions taken in accordance with the person’s needs and wishes. These should be regularly reviewed and decisions revised accordingly.
• Sensitive communication should take place between healthcare professionals and the dying person, and those identified as important to them.
• The dying person, and those identified as important to them, should be involved in decisions about treatment and care to the extent that the dying person wants.
• The needs of families and others identified as important to the dying person should be actively explored, respected and met as far as possible.
• An individual tailored plan of care should be agreed, coordinated and delivered with compassion.This includes support to eat and drink as long as they wish to do so, as well as symptom control and psychological, social and spiritual support to ensure their comfort and dignity.