Abstract:

BACKGROUND:
In the Netherlands, out-of-hours primary care has been re-organized from small on-call rota groups to large-scale GP co-operatives. However, out-of-hours palliative care is an area of concern. According to studies in the UK, the transfer of information about terminally ill patients to GP co-operatives seems to be poor, resulting in care that is often inadequate. Our aim was to investigate the experiences of GPs in the Netherlands about the quality of out-of-hours palliative care provided by GP co-operatives, and to identify elements of care that might need to be improved.

METHODS:
Setting: General practice.

DESIGN:
Qualitative study, using three focus group discussions, analysed in a qualitative descriptive approach.

RESULTS:
GPs participating in the focus groups, considered the quality of out-of-hours palliative care that is provided by GP co-operatives to be meagre. The service provided by the co-operatives was designed for acute medical problems, rather than for palliative care needs. The GPs reported three major problems: ( 1 ) lack of adequate information at the GP out-of-hours service; ( 2 ) lack of anticipatory care during office hours; and ( 3 ) absence of a palliative care policy in the GP co-operatives.

CONCLUSIONS:
Although GP co-operatives are capable of providing continuity in palliative care, improvements could be achieved if GPs and GP co-operatives address the problems mentioned above.