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CAMHS won't see you now

GPs avoided LCP before media storm

It is genuine concerns that lie behind the profession’s caution, not GPs being influenced by the press, says Dr Alison Lloyd

Pulse reported that the RCGP thinks GPs are avoiding the Liverpool Care Pathway because of ‘adverse publicity’, but I think the RCGP has got this the wrong way round.

GPs have stopped (or never started) using the LCP and other pathways for four main reasons: it implies a ‘one-size-fits-all’ programme, leading to certain death without individual choice; clinicians can sometimes follow it to the letter and fail to show flexibility; there is a feeling among some GPs that incentivising us to put people on the pathway with a ‘target number’ is inappropriate and insensitive; and it can be difficult to be sure that a patient is in the last six to 12 months of their life, but putting them on an ‘end-of-life’ ‘pathway’ makes it a certainty that will be acted upon.

The LCP can be a useful guide for those who are inexperienced or lack the experience to provide the best care, but it is these genuine concerns that lie behind the profession’s caution, not GPs being influenced by the press.

Dr Alison Lloyd, Twickenham

Readers' comments (2)

  • I agree. I had a patient dying at home in end stage renal failure. One of the palliative care nurses asked if we should put him on the Liverpool Care Pathway. I can't really explain why but it just felt wrong. From conversations I' d had with him about dying I knew my patient would hate to have it suggested he be put on any kind of pathway. I said " Let's look after him as well as we can, and make his last days as comfortable and supported as possible, " and we did, and he had a good death. Do you need a pathway to provide humane end of life care? I understand its meant to ensure everything is done that shoud be done, but I am not sure structured pathways are the best way.

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  • The only time I put patients on the pathway is when the swallowing reflex has gone and the patient needs injectables. When on the pathway, all participants in care provision know where they stand, how to record findings, make sure enough injectables etc. It is a very valuable tool to help in terminal care provision and just because it has been used inappropriately by some it should not be denied to the rest of us. What I find far more distressing is having to discuss do not attempt CPR with a patient.

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