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The waiting game

GPs ‘should continue to take individual approach to DNR forms’

NHS England has asked GPs and other healthcare professionals to avoid any 'blanket' policies on clinical decisions during the coronavirus (Covid-19) epidemic, especially with regards to do-not-resuscitate forms.

GPs should 'encourage' the 'most vulnerable' patients to 'discuss their individual wishes and concerns regarding their treatment preferences should they develop Covid-19 symptoms and record those preferences in an advance care plan', it said.

The guidance comes as last week, hundreds of practices in North West London were advised to tell the relatives of care home patients who lack capacity that ‘difficult decisions’ will need to be made around admitting these patients to hospital.

NHS England's letter to GP practices, PCNs, CCGs, trusts and community health services said: 'The key principle is that each person is an individual whose needs and preferences must be taken account of individually.

'By contrast blanket policies are inappropriate whether due to medical condition, disability, or age.'

The letter, signed by NHS England national medical director Professor Stephen Powis and chief nursing officer for England Ruth May, added: 'This is particularly important in regard to "do not attempt cardiopulmonary resuscitation" (DNACPR) orders, which should only ever be made on an individual basis and in consultation with the individual or their family.'

A joint statement from the BMA, RCGP, CQC and the Care Provider Alliance added that 'where a person has capacity, as defined by the Mental Capacity Act, this advance care plan should always be discussed with them directly'.

The statement said: 'Where a person lacks the capacity to engage with this process then it is reasonable to produce such a plan following best interest guidelines with the involvement of family members or other appropriate individuals.

'Such advance care plans may result in the consideration and completion of a Do Not Attempt Resuscitation (DNAR) or ReSPECT form.

'It remains essential that these decisions are made on an individual basis. The general practitioner continues to have a central role in the consideration, completion and signing of DNAR forms for people in community settings.'

 

Readers' comments (2)

  • All community patients should now be DNAR by default.

    CPR is an AGP and is not safe without high level PPE. Out of hospital resuscitation always had poor results anyway but in the case of COVID19 the hypoxia is unlikely to be reversible without intubation and ventilation. This is far too dangerous, we need to stop now or risk other people becoming infected.

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  • For the care home patients just get the forms signed. Don't send "death letters". Well intentioned-but will cause a lot more anxiety and anger.

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