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Tick-boxing has 'no place' in the unplanned admissions DES, says NHS England

There is ‘no place’ for GPs or nurses to adopt an ‘insensitive tick-box approach’ in the completion of care plans for the unplanned admissions DES, NHS England has said, in response to the recent controversy over a ‘do not resucitate’ question.

It told Pulse that the approach had led to ‘disturbing’ media reports and it was ‘fundamental’ that doctors communicate with patients in a ‘compassionate and sensitive way’.

The comments come after NHS England announced yesterday that it would be reviewing the care plan template in response to claims in the Daily Mail that care coordinators for the DES were ‘callously’ asking patients to sign DNRs as part of some of the questions on the form.

It also comes only a few weeks after GP leaders warned that a lack of leniency from NHS England in meeting the DES requirements would mean GPs would end up with no option but to run it as a ‘tick box exercise.’

NHS England did not comment on whether practices that have used the template for the completion of care plans so far should stop using it until the review was completed, but said that the template is just an aide for completing the DES and practices are entirely free to develop their own form.

It said it will also be reviewing the guidance around the DES with the BMA to ensure those completing care plans were aware that they should use ‘professional judgement’ on whether its appropriate to discuss end of life care with a particular patient.

An NHS England spokesperson said: ‘Communicating with patients in a compassionate and sensitive way is fundamental to being a doctor, nurse or any health professional.’

‘This comes down to professional judgement and there is no place for the kind of insensitive ‘tick box’ approach to such conversations as highlighted in the disturbing accounts in the media.’

‘We will be reviewing the guidance with the British Medical Association, to ensure that there is no room for misinterpretation in how it should be used.’


Readers' comments (20)

  • Tickles me when I think I was almost tempted to take up this DES. Wonder what my naive GP colleagues thought when they dived head first into this swamp. Did anybody think that this DES was a way to return them the money that was taken off from QoF? Govt has a hideous plan of liquidating the NHS in its present state and what better way to do it than also watching the funny sight of GPs thrashing around trying to recover the unrecoverable. Bet Cameron and Hunt are bursting their sides laughing.

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  • Vinci Ho

    'Well said' , NHSE
    Saying something so politically correct is like telling me my mother is a woman and my late father was a man.

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  • Ha Ha, give GPs a tick box form to complete in order to earn a living and then accuse GPs of having an insensitive tick box approach to it! You just couldn't make it up.

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  • Ivan Benett

    Why do we become GPs if not to keep people well, and keep them out of hospital? It's not for the money surely.

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  • q 386 compassion used [ ] tick to confirm

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  • Yes, saying that the tick boxing has no place in the DES is a bit like saying that sugar has no place in candy floss.

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  • Utter tripe from NHSE which is the very same body that has said it will refuse to pay practices essential (as opposed to extra) funding from this DES should they not a box or apply a code exactly as laid down in the specification.
    It is clear that there was never any intention to pay the money that was taken from QOF.

    The BMA in its never ending niaivety has been conned again.
    I bet next year there will be more money taken from QOF which will be tied up in red tape with the intention that we we should try (and fail) to earn it back.
    I used to think general practice had about 5 years realistically till it all collapses... it give it 2-3 years at best.

    Everyone should start making alternative plans.

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  • Design our own template??

    I assume so that NHSE can claim we've not done things to their satisfaction and refuse to pay us.

    p.s. I doubt BMA/GPC are being "conned". No one is that naive. I suspect they are in this together on the government's side.

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  • Tick here to indicate you did not use a tick box approach []

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  • Ivan, we become gps not for the money but to provide good care and a rewarding career for us. Great care includes doing the best for a patient and if that care needs to be in hospital, so be it. Our job is not to keep patients out of hospital when that is the best option for them in order to save money.

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