Abstract:
Background: International studies have highlighted the potential to improve coordination and minimize fragmentation of care for people living with palliative care need through a partnership approach involving generalist services and specialist palliative care teams. With the future focus on care in the community, the role of the general practice team and how they work with specialist palliative care teams will be key to responding effectively to a projected increase in palliative care need internationally. To date the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. Aim: To explore how general practice and specialist palliative care teams view their relationship in terms of partnership working. Methods: Five focus group discussions were conducted with clinical and service leadership staff from two general practices, two hospice specialist palliative care teams and one hospital palliative care team. The services were drawn from two different District Health Boards in New Zealand, one metropolitan and the other more provincial. Thirty five staff from the five teams took part. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach. Results: Three distinct themes that informed participants’ understanding of partnership working were identified. These were: one’s identity as a generalist or a specialist, rules of engagement, and the quality of relationships between general practice and specialist palliative care teams. The study found that considerable commitment to partnership working was shown by general practice and specialist palliative care teams in delivering palliative care. However, the study also identified that their working relationship is based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. These findings have implications for equity of access for people with palliative care need and the need for clarity around roles and responsibilities. Conclusion: This study indicates that considerable challenges are faced by clinical staff endeavouring to meet the needs of people with palliative care need across the complex terrain that is the community setting. It illustrates tensions between the cultures of ‘generalism’ and ‘specialism’ and makes recommendations regarding the potential for greater collaboration. Future research directions are identified; in particular referral management, formal partnership frameworks and the potential contribution of advanced practice nursing roles.