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'Do not resuscitate' form is not fit-for-purpose, say GPs

A form introduced across Wales to record whether patients with life-limiting illness or severe frailty wish to be resuscitated is ‘not fit for purpose’, NHS Wales has been told by GPs.

The GPs argue that the form is old-fashioned and unwieldy because it requires carbonated paper and has six copies, and it is not clear where all of them are supposed to be sent.

NHS Wales is reviewing the style of the form and has pledged to bring in an electronic version next year after the GPC and RCGP passed on GPs’ concerns.

Some GPs have not even received the form, even though NHS Wales had said it was compulsory from August 1.

NHS Wales introduced the standardised ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) form across both primary and secondary care to provide a ‘consistent and integrated approach’ so that patients and families feel involved in decisions about resuscitation. It has sections summarising why CPR might be inappropriate, whether the patient has capacity to make decisions about CPR, and whether carers/families have been involved in discussions.

But the Bro Taf LMC said in its August newsletter: ‘We know that some practices have expressed concern that the new DNACPR form is not fit for purpose for primary care. The new form is all Wales, not local, and it appears that primary care was not adequately engaged in its development. The form will be reviewed and the Primary, Community and Intermediate Care (PCIC) team of Cardiff and Vale UHB has told us that it will feed GP concerns into this review.’

Dr Jacqueline Gantley, a medical secretary for Bro Taf LMC and a GP in Cardiff, said that when she puts pen to paper on the top sheet the writing only goes through the first two or three sheets, requiring her to rewrite everything at least once more.

Dr Gantley said: ‘Among the six copies, one is English for the patient, another is in Welsh, and one is for the practice. Another is for audit purposes, although I’m not sure who audits it. It’s a peculiar idea because we don’t really use paper anymore. We’re trying to do away with paper notes.’

She added: ‘GPs that cover nursing homes will be using these forms reasonably commonly. I just can’t imagine that anyone in primary care thought this type of form is a good idea.’

Dr Jane Fenton-May, a vice-chair of RCGP Wales, said: ‘After you’ve filled in the top sheet of the new form you have to go back and fill in the other sections again. You have to have strong pens to fill it in. I hope that this form will be computerised so we can link one part of the health service to another.’

Implementation across Wales is ‘patchy’ so far, despite the August 1 deadline, she added.

Readers' comments (4)

  • Write your own form. We have a single paragraph letter. There's no obligation to use anyone else's, whether fit for purpose or not. Personalised care.
    Regards
    Paul C

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  • Double face palm for this task force.

    Why are centralised solutions STILL being chased.
    Decentralisation is the 21st century way!

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  • Every patient, young and old, should be encouraged to write their own advance directive.

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  • Anonymous | GP Partner | 01 September 2015 8:40am

    I think you'll find we go on a cycle (roughly 10 years in corporate sector, a bit slower in public) of decentralisation and then recentralisation. Just wait for the pendulum to swing.

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