Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey

Background Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. Aim To understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. Design and Setting A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020. Method Responses were analysed using descriptive statistics and an inductive thematic analysis. Results Valid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. Conclusion Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics. How this fits in (4 sentences) ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no financial support for the research, authorship and / or publication of this article. Dr Sarah Mitchell and Dr Catriona Mayland are funded by Yorkshire Cancer Research Connects Senior Research Fellowships. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the University of Sheffield Research Ethics Committee (UREC) Ref No: 035508. Approved 28.7.20 All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are available upon reasonable request to the corresponding author.