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GPs avoiding Liverpool Care Pathway 'due to adverse publicity', says RCGP

Exclusive Negative publicity surrounding the Liverpool Care Pathway is causing some GPs to avoid using it in patients nearing the end of their lives, the RCGP has told a Government review into the pathway.

The college said that the controversy surrounding the palliative care pathway in the press meant it has become a ‘barrier’ to communication with patients for some GPs and is often avoided.

The LCP is recommended by NICE and the Department of Health as the best practice model for end-of-life care, and it is designed to improve the care of the patient in the last hours or days of life.

Last year numerous media stories claimed elderly patients had been refused food and water to speed up death and that neither they, nor relatives have been told doctors consider their case to be terminal. Trusts were accused of being incentivised to put elderly patients on the pathway to cut costs.

In response to the attention, earlier this year the DH announced that former Kings Fund chief-executive Baroness Julie Neuberger would chair a review to examine the LCP, which will publish its findings this summer.

As part of its written response to the review, the RCGP said that while some GPs said the LCP was useful in giving GPs a framework for prescribing, and was useful for newly qualified GPs, who may need more guidance on how to deliver palliative care, many said the volume of paperwork associated with the pathway and the negative publicity surrounding it meant they avoided using it.

The response document said: ‘Some GPs said that they used the principles of the LCP - and found these helpful - but did not use the pathway itself. Respondents mentioned both the volume of paperwork associated with the LCP, and the recent adverse publicity surrounding the pathway as reasons for not using the LCP itself.’

It added: ‘A problem with implementation of the LCP flagged by some GPs focused on the negative publicity that the LCP has received recently. Respondents felt that use of the LCP can cause additional concern amongst relatives, who may feel that their loved ones are being condemned to a standardised ‘model of dying’.

‘One GP said: “More recently [the LCP] can be a barrier, rather than a tool to aid communication and planning for a dignified death.”

Some GPs felt the word ‘pathway’ did not aid communication with relatives and patients, as pathway suggests a standardised approach to care. They advocated re-naming the LCP as ‘best practice’ or ‘guidelines’, the response said.

GPs also suggested there should be tighter guidelines around the use of provision of IV fluids within the LCP as this was a source of concern for patients, better communication by healthcare professionals about how patients can come off the pathway if necessary, as well as improved communication between primary and secondary care.

In their response to the review, the BMA’s Medical Ethics committee said it ‘strongly supports’ appropriate use of recognised frameworks for end of life care such as the LCP, and will ‘continue to discuss and monitor’ the pathway.

Readers' comments (15)

  • I agree with Alison completely.

    Having a frame work to use as a base is helpful. Having inflexible professionals, such as nurses (no offence, but due to the nature of the job, nurses have the tendancy to stick rigidly to the guideline), adhering to the guideline causes problems. Inadequate junior doctor exposure to clinical difficulties leading to inexperienced new GPs also causes the same effect of course.....

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  • I believe that the pathway was developed for a hospital setting and was never appropriate for GPs.

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  • Arisk of being controversial, and exposing myself as an old fashioned GP, I dislike the whole move towards " pathways of care". These are too often interpreted in a dogmatic and inflexible way as the "right" way of doing things and leave the patient shoe-horned into a situation they are not necessarily comfortable with. They are useful as a guide to " best practice" but should be flexed to meet an individual patient's needs and preferences.
    Not all patients are the same, and some patients may wish to make choices which are unwise. It is their right to do so.

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  • I absolutely agree Alison.Those pathways of care then come to be established as "best practice" and we then all have to comply.Its all part of the dumbed down tick box culture that has been foisted upon us.What choice do we have when it all becomes part of QoF and our income then depends on it?But that is what's wrong with modern general practice isn't it.Idiocy is trampling over commonsense.

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  • Gerbo Huisman is absolutely correct
    - the advance completion "authorises" an non medic to start a therapy- or put in correct GMC terms "Delegates the Doctors professional autonomy to another for administration of therapy."

    someone else does it but you "carry the can" at inquest if they made an error.

    Ask yourself the GMC question:-

    "what steps had I taken to be assured that ALL individual who MAY initiate the pathway where personally suitably qualified to make a decision on initiation?"

    If you cannot answer this in a way you would be happy to relate at the new Medical Tribunal Hearing you should not delegate this task.

    I have seem reems of proof local staff are trained in the operation of the equipment and technical skills but none that the the average community nurse has any formal diagnositic training to be able to correctly identify the need to start the pathway.

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