ABSTRACT
The importance of generic palliative care skills has been emphasised elsewhere in this book. Generic palliative care is that which should be provided by all healthcare workers irrespective of specialty and setting. The principles of symptom control based on a holistic assessment that includes physical, psychological and spiritual domains should be familiar to all health professionals, and should be sufficient to deal with all but the most complex issues. Increasingly, nursing staff in particular are becoming aware of patient needs in these areas, and heart failure nurse specialists, district nurses, practice nurses (who have often gained great skill in running chronic disease management clinics) and community matrons can play an important role in co-ordinating care. Sadly, however, this does not always extend to the cardiologists, who may not see this area as part of their remit or skills, even to recognise and refer on, and feel too pressurised in busy clinics to deal with anything other than the obviously cardiological medication. Most general practitioners will be involved with patients who have advanced heart failure, and have experience of palliative care, but GP skills relating to chronic heart failure may be variable.
