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End-of-life care and your practice

Our expert from the Medical Protection Society dissects the latest GMC guidance on end-of-life care and looks at what it means for your practice

In July this year, the GMC issued new guidance on end-of-life care and this covers several key principles that all GPs should be aware of and is a good reason to review practice processes regarding terminally ill patients.

The guidance looks at advanced care planning, and how to deal with disputes and disagreements and capacity. In a busy practice the key to implementing GMC guidance is to be aware of the potential challenges and have a clear policy in place.

This article looks at how practices can do this.

Identifying patients

The practice needs to be able to identify the patients who fall within the GMC criteria, such as those who are generally frail with coexisting conditions, which means they are likely to die within the next 12 months.

Maintaining practice records

Once a patient is identified, this needs to be recorded in the medical records. The treatment options and advance care planning, as spelled out in the GMC guidance, will then need to be addressed.

Ideally this should be done in such a way as to maintain continuity of care and consistency, which will also help in building relationships with the patient and any carers or family.

Of course complete continuity can never be guaranteed, so it is essential that careful up-to-date records are kept. Make sure all decisions and reasoning is thoroughly documented in the notes, including:

• details of discussions with the patient or any proxy decision maker

• the agreed care plan

• the existence of any advance decision, proxy decision maker, or relatives who may need to be involved if the patient lacks (or loses) capacity.

Developing a document or check list within the practice, can be valuable, as it will maintain consistency, and ensure that all steps are taken. Find out if such a tool has already been developed, as a consistent local approach can be valuable.

If there is no local resource that the practice can adopt, then you could draw up your own, or ask the PCT to help coordinate a larger local initiative.

You should consider covering the following points in your process:

• how to identify patients who fall within the GMC’s end-of-life criteria

• document the lead clinician(s) or health professional(s) taking responsibility in the case

• the existence and substance of any Advance Decisions

• any assessment of the patients mental capacity

• record the identities of any relatives, carers or proxy decision makers

• when and how to have any discussions with the patient or any other party

• agreed care plans

• determine any review dates for the above points

• arrange any necessary staff training, and select a review date for the entire process.

In this evolving area of law and ethics the guidance provides a comprehensive and structured approach to what are often difficult and sensitive situations. The challenge for GPs and practices is to become familiar with the guidance, particularly as end of life treatment decisions may need to be made quickly and in challenging circumstances.

Dr Jo Galvin is a medicolegal adviser for the Medical Protection Society

End-of-life care and your practice