Palliative Care Australia (PCA, the peak body for palliative care) has released three documents to guide service development and structure for palliative care over the coming years.

The first document is the Standards, which was summarised in the last edition of GPSpeak. The second document is ‘A Guide to Palliative Care Services Development, a Population Based Planning Approach’. The third document is ‘Service Provision in Australia, a Planning Guide’. All documents are available on www.pallcare.org.au. The documents provide a platform to look at providing equitable access to palliative care in the context of efficient, effective and ethical use of resources. PCA is taking a population-based approach to palliative care in that it is looking at the health needs of the target population as a whole, i.e. every patient identified with a life-limiting illness and a palliative need, rather than just those patients referred to palliative care services.

There are about 134,000 deaths in Australia each year. 64,000 of those deaths are considered to be expected, i.e. the death is related to a diagnosed life-limiting illness. Of those 64,000 people, one-third are referred to specialist palliative care services. Therefore, when looking at end of life care it makes sense to look at the whole population rather than the minority of patients who are actually referred to palliative care services.

The structure for this is to divide palliative care providers into two groups, primary care providers and specialist palliative care providers. Primary care providers are health service providers who have a primary or “first contact” relationship with the patient and provide a palliative approach. This would include GPs, community nurses, allied health, aged care services, acute care services and other specialist services, e.g. oncology. The role of primary care services would be to use a palliative approach in the delivery of care that includes:
1. Assessment and control of pain and symptoms;
2. Provision of holistic care, which includes psychosocial, emotional, social and family support;
3. Assessment and referral to specialist services when the needs exceed capacity of primary care services. Capacity in this instance may relate to either skills or resources.

Specialist palliative care services fall under three broad groups that are based on resources. Specialist services would be expected to:
1. Provide care for patients with complex end of life care requirements and needs;
2. Provide consultation and direct care in partnership with primary care providers;
3. Provide education, research, leadership in specialist palliative care.

How the various services relate to each other is described in the ‘Framework for palliative care service planning’ below.

The advantages of this framework means there are formal links between services; patients access services according to their level of need (and not simply because they have a cancer diagnosis); there is ultimately appropriate use of resources; and there is improved quality and coordination of care.

The four tiers of service resource level (1 primary, 3 specialists) are mapped to the new palliative care standards. This means that all services are expected to meet a minimum requirement for providing palliative care according to their level of resources. All health care providers will be expected to meet primary care standards.

Summary
There are 3 documents guiding service palliative care service development.
1. Population based planning includes ALL patients requiring end of life care, not just those referred to palliative care services.
2. Patients access services dependent on their needs not diagnosis.
3. Needs based referral thresholds mean the right patient is seen at the right time in the right place by the right service.

Dr Joanne Doran is the area medical director of palliative care at the North Coast Area Health Service. Email jdoran@svh.org.au.