Community end-of-life care during COVID-19: Findings of a UK primary care survey

Background
Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.
Aim
To understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.
Design and Setting
A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020.
Method
Responses were analysed using descriptive statistics and an inductive thematic analysis.
Results
Valid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.
Conclusion
Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.