For many people, the doctor who knows them best isn’t a specialist in a hospital, it’s their GP! Someone who’s seen them through countless illnesses, who knows their story, their family, and their background.  

Emeritus Professor Geoff Mitchell at The University of Queensland believes that continuity is the key to better end-of-life care. “I’ve always thought GPs should be doing palliative care,” he says. “What I realised is that they are already doing palliative care, whether they realise it or not.” 

Primary care 

When most people hear palliative care, they picture the final weeks of life: intense symptoms, rapid changes, a flurry of hospital admissions. But that view is narrow. In reality, palliative care spans months or even years, addressing physical symptoms, emotional wellbeing, family support, and planning for the future.  

Geoff sees another dimension of care, one that begins quietly, often months before death, almost imperceptibly. It’s the time when families and patients can start preparing, understanding what might happen, and putting in place practical and emotional support. “That’s the time when you can prepare,” he explains. “You can make sure people understand what might happen, what to expect, and how to make it easier when the time comes.” 

Clinical care planning  

He recalls reading that over 60 per cent of people in New South Wales die without a valid will. “They keep putting it off,” he says. “And then it’s the family who have to pick up the pieces. That’s really challenging.”  GPs can encourage them to do it while they can. 

That kind of preparation, Geoff explains, is part of what he calls clinical care planning. And it’s something quite different from simply filling out an advance care plan. It’s about helping people anticipate and plan for likely scenarios so they can avoid unnecessary panic and distress. 

He gives the example of a patient with advanced heart failure, who will almost certainly experience terrifying breathlessness at some point, often in the middle of the night. “They feel like they’re drowning. It’s absolutely terrifying. Without preparation, families call triple zero, and hospital admission follows.” 

But with planning, the outcome can be very different. “There are simple things that can be done to help alleviate a lot of the panic,” he says, “like sitting the person up, opening windows, putting a fan on them.  

“By reducing panic, you reduce the adrenaline and the body’s need for oxygen. Everything calms down. If it’s still bad after ten minutes, then call the ambulance, but often you don’t need to.” 

Why a specialist isn’t always ‘better’  

Despite these clear benefits, many GPs hesitate to take on palliative care. “There’s often a sense that a palliative specialist will do it better,” Geoff observes. “But GPs have the skills for about 70 per cent of palliative care situations. What I want to see is people take that 70 per cent on. The more you do it, the better you get.” 

Fear is a compounding factor. In aged care, nurses with the legal right to treat end-of-life pain with opioids sometimes choose not to, worried about being punished for doing the wrong thing. Geoff’s approach to risk is different. “Medico-legal risk is minimised by doing your best, working to your maximum capacity, being careful but also making sure that your patients are your friends.” 

Geoff has seen the difference good primary care-led palliative care can make. He describes a project where a nurse practitioner worked with nursing homes: assessing residents, setting up care plans, training staff, and working with the patient’s GP. “She came in, identified needs, encouraged and supported staff to enact plans, and made herself available. It was superb.” 

The outcomes were striking: major reductions in inappropriate hospital admissions, improved staff confidence, and better symptom management. Queensland has since implemented this approach statewide through the SPACE program - Specialist Palliative Care in Aged Care - ensuring families and care staff are supported while GPs maintain continuity.  

Building on what’s already there 

Geoff says the solution isn’t revolutionary. “It’s education programs that build confidence, support when GPs choose to work at full capacity, and better use of existing Medicare provisions,” he says. “The biggest thing is recognising death isn’t failure. It happens to all of us. If you plan ahead, you can calm crises and keep people out of hospital.” 

He also notes structural barriers. Many GPs now work for corporates, where house calls or flexible care are discouraged because they’re “inefficient”.  “If you go the extra mile, like making yourself available by phone out of hours, your patients and their families will be forever grateful. You may have them as patients for life. That “inefficiency” becomes an excellent investment.” 

A shift in mindset is needed too. “Too often GPs think: the specialist will do it better, why am I even trying? But that attitude leaves gaps in care. And the families are the ones who suffer. Primary palliative care needs to be recognised as foundational— part of general practice, supported by specialists as required, not replaced by them.” 

Education, Geoff argues, is essential. From registrar training to continuing professional development, clinicians need both knowledge and confidence to act. And practical systems matter too: clear protocols, phone advice, and preparation for likely events can transform the experience for patients and carers alike. 

“I think primary palliative care is one of the places in medicine where care it happens better than in many other areas,” he reflects. “GPs already have the relationships, the trust, the knowledge. We just need to help them see what they’re capable of.”   

Why continuity matters  

For families suddenly caring for someone seriously ill, that continuity matters enormously. “Most people have no idea, they have no link to healthcare at all,” Geoff says. “Then they’re suddenly thrown the job of looking after someone who’s as sick as anyone you’ll ever see. Planning and support empower them and that makes all the difference.” 

As Geoff looks to the future, he is hopeful but realistic. Change won’t happen overnight, and challenges remain. But the foundation is already there: a skilled, trusted workforce in general practice, capable of providing compassionate, effective palliative care, and in doing so, helping Australians die with dignity, supported every step of the way. 

“Death happens to all of us,” he says. “It’s not failure. But if we plan ahead, we can make it manageable, empowering, and humane, for patients, for families, and for those of us who care for them.”