Introduction – Most people die of non-malignant disease and have a lengthy period of decline. Specialist palliative care services treat mainly cancer– primary care provides the bulk of end stage non-malignant disease. However, many GPs do not feel comfortable in this role. For patients of heart failure and lung health services, we piloted case conferences between the patient’s GP, a palliative care specialist and the specialist nurse to provide a case review and devise a formal palliative care plan. Case conferences were held at the GP surgery. Patients were advised of the plan by the nurse, and had input into plan modification.

Method – Pre-post case conference chart audit (health service and GP) reviewing plan adherence, qualitative study of health professional participants, and service utilization before and after case conference.

Results – Twenty-three cases conferences, one GP refusal to participate. Of 82 recommendations, 55 (67%) were enacted.  Most recommendations related to Physical, Social, Emotional and Personal control. Annualised rate of emergency department (ED) visits fell from 13.9 to 2.1 (p = 0.001), ED visits not leading to hospitalization from 3.9 to 0.4 (p=0.05), inpatient stays from 11.4 to 3.5 (p=0.002) and average length of inpatient stay from 7.0 to 3.7 days (p=0.009).  Participants identified improved communication and clarity of the care plan. Patient data were not collected at this stage of the pilot process.

Conclusion – Substantial improvements in health service utilization appear to result from this process, but this needs to be tested by a randomized controlled trial.