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Guideline of the month: End-of-life care

The guideline to be aware of in December

NICE has released a new guideline on delivery of end-of-life care in adults. It covers conducting a holistic assessment of the person’s needs, coordinating multipractitioner care and advance care planning. It aims to ensure patients have access to services and care that they need and want in the last weeks or months of life, and includes advice for carers.

Key points for GPs

  • GPs should identify carers and others who are important to the person.
  • If a person is thought to be approaching the end of life, carry out a holistic needs assessment with them and document it.
    • Be aware of the need to offer a carer’s assessment, in line with the Care Act 2014
    • Consider what support carers might need and be aware that the needs of a young carer are likely to be different to those of an older carer
  • Support those approaching the end of life to be active in decision making by establishing the amount and type of information they would prefer and the way in which they would like - Be prepared to review communication needs and preferences as circumstances change
  • The lead healthcare professional should ensure the person has the opportunity to discuss and review their treatment plan, including:
    • Any changes that could improve quality of life
    • Community support that can help with their treatment
  • Develop policies to ensure advanced care planning is offered to all adults approaching the end of life.
    • Involve carers in this if the person agrees
  • Ensure good communication between primary and secondary care services when coordinating care.
  • Those providing end-of-life care coordination should ensure that the person and their carers know who the members of the multipractitioner care team are and that their needs are discussed and acted on where possible.
  • Adults approaching the end of life, and their carers, should have round-the-clock access to a healthcare professional who can access their records and advanced care plan, and make informed decisions about any change of care.

Practical considerations

The new guideline particularly focuses on holistic assessment and including carers and loved ones in conversations and planning around the end of life. GPs will need to build in time and processes that allow for conversations about needs and preferences.

Patients will also need access to out of hours medical care and pharmacy, which will need to be considered and coordinated by the lead GP.

GPs will also need to build in clear communication strategies with secondary care so that all plans and any changes are relayed quickly between clinicians.

What the experts say

Dr Paul Perkins, chief medical director at Sue Ryder and consultant in palliative medicine, says: ‘My suggestion for busy GPs would be to head straight to the recommendations and take a moment to think about whether there are any gaps in your area where working with your local specialist palliative care providers could help.

‘Sue Ryder runs seven specialist palliative care units across the country and we see the best outcomes for the patients and families we support when we work hand in hand with local commissioners and healthcare teams to find the right clinical pathways.’

The guideline

NICE. NG142 End of life care for adults: service delivery. London, NICE, 2019

Related images

  • end of life care 535x350

Readers' comments (2)

  • I had an interesting chat with a neighbour last week, he was sad because he had to put down an old sheep that was suffering and had he not done so he could have been prosecuted for animal cruelty. He then commented that when his grandfather was in similar condition a year ago he suffered terribly in the last week or so but nothing was done by the doctors in case they were prosecuted for murder. He's not medical and it was just a sad observation but actually quite an interesting thought, I know which option I would prefer for myself.

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  • Agree.
    I have heard such comments in my surgery as "..if s/he were a pet/animal, we would have put them down..." when talking about recent deaths of [especially] elderly relatives in the EoL situation.
    Of course we are not pets or "animals" but I do empathise with their distress.

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