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GPs avoiding Liverpool Care Pathway ‘due to adverse publicity’, says RCGP

Exclusive Negative publicity surrounding the Liverpool Care Pathway is causing some GPs to avoid using it in patients nearing the end of their lives, the RCGP has told a Government review into the pathway.

The college said that the controversy surrounding the palliative care pathway in the press meant it has become a ‘barrier’ to communication with patients for some GPs and is often avoided.

The LCP is recommended by NICE and the Department of Health as the best practice model for end-of-life care, and it is designed to improve the care of the patient in the last hours or days of life.

Last year numerous media stories claimed elderly patients had been refused food and water to speed up death and that neither they, nor relatives have been told doctors consider their case to be terminal. Trusts were accused of being incentivised to put elderly patients on the pathway to cut costs.

In response to the attention, earlier this year the DH announced that former Kings Fund chief-executive Baroness Julie Neuberger would chair a review to examine the LCP, which will publish its findings this summer.

As part of its written response to the review, the RCGP said that while some GPs said the LCP was useful in giving GPs a framework for prescribing, and was useful for newly qualified GPs, who may need more guidance on how to deliver palliative care, many said the volume of paperwork associated with the pathway and the negative publicity surrounding it meant they avoided using it.

The response document said: ‘Some GPs said that they used the principles of the LCP - and found these helpful - but did not use the pathway itself. Respondents mentioned both the volume of paperwork associated with the LCP, and the recent adverse publicity surrounding the pathway as reasons for not using the LCP itself.’

It added: ‘A problem with implementation of the LCP flagged by some GPs focused on the negative publicity that the LCP has received recently. Respondents felt that use of the LCP can cause additional concern amongst relatives, who may feel that their loved ones are being condemned to a standardised ‘model of dying’.

‘One GP said: “More recently [the LCP] can be a barrier, rather than a tool to aid communication and planning for a dignified death.”

Some GPs felt the word ‘pathway’ did not aid communication with relatives and patients, as pathway suggests a standardised approach to care. They advocated re-naming the LCP as ‘best practice’ or ‘guidelines’, the response said.

GPs also suggested there should be tighter guidelines around the use of provision of IV fluids within the LCP as this was a source of concern for patients, better communication by healthcare professionals about how patients can come off the pathway if necessary, as well as improved communication between primary and secondary care.

In their response to the review, the BMA’s Medical Ethics committee said it ‘strongly supports’ appropriate use of recognised frameworks for end of life care such as the LCP, and will ‘continue to discuss and monitor’ the pathway.


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