GPs or consultant to lead expansion of palliative care?

THE palliative care service will expand - although no decisions are likely until next year. Two schemes are emerging as front runners: a more expensive service led by a consultant, or a cheaper one run by three GPs with special training.

Health minister Peter Roffey said earlier this year that the preferred option was broadening the service with three GPs with diploma training, perhaps supported by a visiting consultant.

But he said there were now 'ongoing discussions' between Dr David Jeffs, the director of public health, and Les Bourgs Hospice to look at another model.

This is understood to be some form of consultant-led service - which is said to be preferred by Les Bourgs, the palliative care nurses, the Cheshire Home and the Medical Specialist Group.

Deputy Roffey said: 'The consultant-level service has not been ruled out.'

But, he said, 'if all our eggs were in one basket, between holidays and professional development, there would be significant periods with no one with specialist training in palliative care in the island.'

The consultant choice is the most costly but Deputy Roffey said that although funding was a consideration in everything, in this case it was not the driving force.

Palliative care aims to relieve pain and distress among seriously ill and terminally ill patients, but offers comfort rather than cure.

Three years ago the cancer strategy group recommended the appointment of a consultant in palliative care.

But Dr Jeffs said that this was something 'that looked right two or three years ago but may not necessarily be right for now'.

Dr Nick King, who is on the medical board of Les Bourgs, supports the appointment of a consultant.

'There are many instances where the expertise of a palliative care consultant would be helpful to manage patients' symptoms.

'It would be difficult to evolve that level of expertise with just GPs.'

Having such a specialist would take a load off the acute physicians and the oncologist ,Dr Peter Gomes.

Dr King said he would like to see that specialist based at Les Bourgs rather than at the Medical Specialist Group.

'The post could tie all the loose ends together.

'But it would be a major effort involving the MSG, Health and the hospice.'

The MSG said it broadly supported the appointment of a consultant in palliative care.

Dr Jeffs said:'This has to be a political decision.

'The States needs to decide how much it wants to spend and what it spends it on.'