Doctors from Maastricht
Our Hospices have a continued successful partnership with Maastricht University in the Netherlands.
The UK palliative care system is viewed by many nations as being significantly advanced; indeed, hospice care as we know it has its origins in Dame Cicely Saunders, Founder of the modern hospice movement. As a result, medical staff from other countries look to industry professionals in Britain for expert opinions, innovations and research in the field. For this reason, Woking Hospice is seen as an attractive place for GP Trainees from Maastricht University, the Netherlands, to visit for work experience. Woking Hospice welcomed its first GP registrars from the country in 2001 and has been accepting regular visitors from there ever since.
Every three months, GP Trainees who have chosen the Surrey based hospice as their elective out of a number of different options, both at home and abroad, arrive here to undertake a six week placement scheme. They stay with a family and work alongside teams at the hospice, playing an integral part in the care of patients for the duration of their time here. The aim is to take what they have learnt back to their practices in the Netherlands as well as endeavour to bring their ideas and experience to the clinical team in England.
The Project History
Fiona Bailey, outgoing Medical Director at the hospices, explains the project from the perspective of Woking Hospice:
“In Dutch Hospices, patients are cared for by volunteers, under supervision of a professional nurse, and under responsibility of their own GP. Besides these mini-hospices there are as many hospices, which are situated within in a nursing home, where patients are cared for by the staff under responsibility of a nursing home doctor. Focus of palliative care in Holland tends to err more towards autonomy with decisions about the individual’s own end of life plans, whereas in the UK, the hospice environment is more one of care and is driven by the needs of each individual patient; there is a more holistic approach to symptom control. For example, UK hospices put great deal of emphasis on family support and complementary therapies. Pets are also allowed into the hospices which is something very new for our visitors from Maastricht. In return, the Dutch Doctors are exceptionally skilled GPs and we learn a lot through discussing our patient’s medical needs with them. GPs in the Netherlands tend to take the lead on most medical decisions as opposed to UK GPs who are obliged to refer patients to specialists, meaning that the Dutch Doctors have lots of advice to offer from their own personal experience. Each system has its merits and there is something to be learnt from both.
Hearing about how end of life care is approached in a different country broadens your horizons and opens your mind to new ways of thinking. It is also great to work with enthusiastic GPs who are willing to present different ideas and engage with everyone. It is wonderful to know that we in England are having an impact on how people near the end of their lives are cared for in another country.”
Stephan Widjaja, a GP Trainee from the Netherlands and on the penultimate week of a 6 week placement from his university in Maastricht, in July 2016, when he explained the programme from his perspective:
“As part of our training in the second year we have two electives. Chronic diseases are looked after across many different areas including rehabilitation centres and nursing homes. We have 150 small hospices in the Netherlands and the number is growing. However, palliative care is very different there. For most of the population they have no palliative care options except a nursing home. There is also a very limited palliative care system in general, with the GP doing most of the service coordination, for example contacting the district nurses and referring patients to the Palliative Pain team at the hospital. GPs in the Netherlands have around 2500 patients on their books at any one time, access to a GP is 24/7 so they are busy people!
The system you have set up over here for care in the home is excellent. Patients in the Netherlands have no access to the hospital or secondary care except for through their doctors; GPs see a lot of patients at home too. Britain is really advanced in palliative care. Nothing back home is quite as good as here, and in my opinion too many people die unnecessarily at hospital instead of in a hospice or at home where they want to be.
I’m learning a lot here about how the hospice works. In addition to caring for people in the last days of their lives, the hospice provides respite care and symptom control. The community care is also superb here, for example the Advanced Care Plan (ACP) is really good; it encourages frail or elderly people to look less at preventing and more at preparing for inevitable scenarios, for example a fall or sickness. Asking questions that make patients think about these things and accept that they are likely to happen, allows them to discuss it openly so that when it happens it is easier to deal with.
I believe that palliative care consultants see problems here a lots quicker than we would at home, they are decades ahead of us in terms of knowledge, allowing them to fully understand new treatments and medications as they are available.
At Maastricht University, we are really blessed to have Woking Hospices on our list of electives for work experience; it’s quite unique. I am learning so much, I could stay another 6 weeks! Everyone works as a team and communicates to each other. I get to know so much about my patients because my colleagues take time to learn about them as individuals; it was a lot to take in at first but now I am getting the hang of it. Some of my peers on the course have either been here already or are due to come to the UK soon. I hope this scheme continues as it’s a really excellent opportunity and I am going to take a lot of what I learnt back with me to the Netherlands.
Although the majority of people think that a hospice is a sad place, and this is universal, I feel that they can also be a place for people to relieve the burden – because it’s hard enough as it is to deal with what they are going through. We have a very serious, professional atmosphere but there is plenty of room for laughter. People pull my leg all the time; I think that being part of a small team helps with this. I also think that the people really make the system work. If the hospice tried to operate on half the amount of staff then it wouldn’t work well, because the workload would increase and then we would not have time to give the proper care that our patients need.
Some of my peers on the course have either been here already or are due to come to the UK soon. I hope this scheme continues as it’s a really excellent opportunity and I am going to take a lot of what I learnt back with me to the Netherlands.”