Definitions of palliative care1,2 specify a holistic, person-centred approach; most patients would prefer care like this at any stage of their life, and most clinicians would aspire to provide it for everyone. But these definitions also specify the kind of people who should be offered palliative care: those with ‘serious or life-threatening health problems’ 1 or ‘a life-limiting (terminal) illness’.2 Practical initiatives like the UK’s Daffodil Standards3 narrow the eligibility criteria, offering guidance about ‘advanced serious illness and end of life care’ and thus introducing a prognosis-based criterion. Unfortunately, ‘advanced’ is vague, and the end of life is variously defined as someone’s last year or days4 or anything in between, and can be identified with certainty only in retrospect. So deciding whether someone is eligible for palliative care is inevitably a subjective process, and identifying those with palliative care needs rests on clinicians reliably and consistently recording their judgements. Despite these challenges, UK GPs are enjoined to create palliative care registers3 and include more people, identifying them earlier;5 so Leach et al’s research6 into patients’ and carers’ experiences of being placed on such a register is welcome.

In the UK, most community palliative and end-of-life care is provided by GPs and community nurses, supported when needed by palliative care specialists. These are people whose time and energy …