Palliative or end-of-life care is very much the domain of the generalist and not the specialist. This is not a bold statement, but rather reality as less than 10% of people die in hospices. It is the generalist, therefore, who oversees the care of the dying mainly in hospitals and, to lesser extent, in the community.
There are three main reasons for a demise. First, hospices receive limited NHS funding as end-of-life care is not a priority thus relying heavily on charitable giving. Secondly, the sad fact is that when GPs relinquished responsibility for out-of-hours care in 2004 through the new GP contract, they also finally severed the continuity of care by the ‘personal’ doctor necessary to adequately care for someone who is dying. It may be anecdotal, but crises in the dying seem to occur out-of-hours and frequently lead to hospital admissions where the acute environment of their care is not appropriate. …