To successfully implement an End of Life care strategy for South Australia

Findings: The barriers to End of Life Care (EOLC) strategies being successful include:

• Failure to identify those living in the last year of life
• Delayed conversations with patients and their families about goals of care
• Advance Care Directives (ACD)/Advance Care Planning (ACP) being seen as the first step to addressing EOLC.

The enablers include:

• Working in partnership across the acute and community settings
• The GP model in the United Kingdom’s National Health Service (NHS) supports home visits and management of EOLC without the need for a fee for service consultation as GPs are salaried NHS employees
• Free access to medicines – ‘Just in case prescribing’
• Appointment of EOL clinical leads to improve experience of dying across the health system.

Recommendations:

• Engage Palliative Care SA (a not-for-profit organisation) to promote and support the Compassionate Communities movement. This work commenced in 2021
• Engage the Gold Standards Framework Team from the UK to train local facilitators in South Australia to promote EOLC identification across all health-related sectors (on hold due to impact of Covid-19)
• SA Health to develop an EOLC consortium made up of representatives from all government and non-government sectors. Palliative Care Clinical Network re-established in 2019 for SA Health to formalise EOLC as a priority by appointing an EOLC lead or commissioner for SA. End of Life Care team appointed within the Department for Health and Wellbeing
• Address the legislation regarding ‘Just in case’ medication packs for people dying at home. South Australian Ambulance Service has undertaken this work in 2021
• SA Health to reinstate the Statewide Palliative Care Research Network previously operating under the Palliative Care Clinical Network. (Not as yet)
• Explore incentives to enable GPs to home visit and better manage EOLC. Keywords: End of Life, palliative care, Compassionate Communities, General Practitioners, End of Life care strategies, Specialist Palliative Care, Gold Standards Framework, undeserved populations.