TY - JOUR T1 - Population-based, person-centred end-of-life care: time for a rethink JF - British Journal of General Practice JO - Br J Gen Pract SP - 116 LP - 117 DO - 10.3399/bjgp18X694925 VL - 68 IS - 668 AU - Keri Thomas AU - Sir Muir Gray Y1 - 2018/03/01 UR - http://bjgp.org/content/68/668/116.abstract N2 - The way we care for people in the last chapter of their lives has been said to be a litmus test for our society. Lifespan now outstrips healthspan, and, with increasing complexity, symptom burden, and rising mortality, the context of end-of-life care (EOLC) is changing and broadening. It is time for a new approach — a reframed, inclusive, big-picture population-based approach to EOLC to meet the challenges of the 21st century.The year 2017 marked 50 years of the UK’s outstanding hospice and palliative care services. Building on this, yet addressing the challenges of today, there is a shift in thinking towards reframing concepts of EOLC to meet the growing needs of the ageing population, and fully integrating EOLC into mainstream care by all providers.People now live longer, with more complex conditions into old age, and with post-baby-boomer demographics our morbidity and mortality rates are rising. The era of the single disease is over1 and with increasing frailty and multimorbidities, the focus shifts from pure survival to outcomes that matter to people. For many people quality of life is more important than quantity of life. With increased access to complex interventions towards the end of life, with potential over-medicalisation and ‘physician-assisted survival’, we face a new tipping point — just because we can, doesn’t mean we should. There is a delicate balance here for all clinicians, particularly GPs, in orchestrating appropriate care, avoiding both over-use of hospital interventions and under-provision of care and support.Stark differences remain between the poorest and the wealthiest in our society, and prolonged ill health pre-dates pensionable ages. Now with more protracted trajectories of decline we have more time to consider how to live well before we die2 and clarify our wishes for … ER -