Palliative care MDTs comprise:
- consultants in palliative medicine
- nurses specialising in palliative care
- other professionals who have specialist experience in providing palliative care services:
- physiotherapy
- occupational therapy
- social care
- spiritual care specialists and psychological services.
In addition, services usually have access to, or shared services provided by, professional groups with specialist knowledge:
- dieticians
- speech and language therapists
- pharmacists
- specialists in interventional pain management.
Palliative medicine consultants attend site-specific cancer MDTs and those for long-term conditions, eg some cancer MDTs, chronic obstructive pulmonary disease (COPD), and renal MDTs. They may also join in primary care MDTs such as Gold Standards Framework meetings.
The overlap between ‘direct’ and ‘indirect’ clinical care (the latter through and alongside others) is significant and job specific. Sole consultant responsibility for inpatient care applies only when patients are admitted to specialist palliative care beds in hospital or a hospice. In community care, the responsibility is shared with the GP. Most other clinical care is a mixture of direct or joint assessment followed by advice on symptomatology, assistance with complex decision-making or availability for case conferences and multidisciplinary meetings. Outpatient work is frequently either joint or alongside other specialties.
Palliative care MDTs work across care settings and boundaries and many physicians hold joint NHS and voluntary sector employment contracts and cover patients in the community, residential facilities and acute hospitals simultaneously.
Palliative care physicians develop and deliver strategies for education and training, especially those for end-of-life care. Most are engaged with planning and development for service provision for the local population. Service configurations for palliative care delivery cross health and social care, the statutory, voluntary and commercial sector and may be very complex. Consultant physicians advise on strategic planning, development, evaluation and commissioning of such services. The place of palliative medicine in the wider community is set out clearly in Ambitions for Palliative and End of Life Care: A national framework for local action 2015–2020 published in September 2015 by the National Palliative and End of Life Care Partnership.