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GPs should provide personal out-of-hours numbers to dying patients as best practice, review suggests



GPs should take on the role of ‘named clinician’ for end-of-life care, and as ‘particularly good practice’ should provide personal contact numbers to dying patients and their relatives to ensure they are reachable out-of-hours, the independent review of the Liverpool Care Pathway has suggested.

The suggestion follows the Government’s announcement earlier this month that a single ‘named clinician’ will be accountable for the care of each older patient with complex health needs at all times when they are out of hospital from April 2014, with the scheme due to be extended to cover all patients in due course.

The review, which recommended yesterday that the Liverpool Care Pathway be phased out within six to 12 months, also called for GPs to be involved in discussions about end-of-life care when patients registered with their practice have no relatives or carers to act as an advocate.

Its main recommendation was that GPs or consultants should take overall responsibility for dying patients, echoing Mr Hunt’s announcement. It said: ‘Patients, their relatives and carers need to know who the senior responsible doctor in their care is. Dying patients must have a named consultant or GP taking overall responsibility for their care.’

It added: ‘In primary care, a patient is now registered with the practice rather than an individual doctor. Some families spoke about the reassurance they had when a GP told them that they were taking clinical responsibility for the care of a dying patient. In some cases, they told us that GPs had provided a telephone number so that they could be reached out of hours in the event of an emergency.

‘The review panel saw this as an example of particularly good practice, and recommends that a named consultant or GP should respectively take overall responsibility for the care of patients who are dying in hospital or the community.’

Dr Dennis Cox, the RCGP representative on the review panel and a GP in Cambridge, told Pulse it was vital that GPs were involved in end-of-life care decisions, particularly where patients had no other advocate. He said that in some cases patients admitted to hospital had been put onto the Liverpool Care Pathway inappropriately because no clinician with a good understanding of the patient’s history and mental state had been involved in the decision.

He said: ‘In those instances – we don’t want the junior doctor to do it, we want the consultant in the charge of their case, when considering whether to put an end of life care plan together, to phone up the GP and talk to them – to say “can you tell me about this patient who’s seriously ill?”, and to get a bit of evidence.’

He added: ‘And if [doctors] say that’s more work for us, then tough. This is what already happens – there are good examples of this.’

The review, chaired by Baroness Neuberger, found widespread failings in how the Liverpool Care Pathway has been used in hospitals and concluded that it should be phased out over the next year.

One key area of concern was accountability for care, with patients, relatives and carers sometimes unaware who the clinician in charge of their care was and when other specialists – particularly members of the palliative care team – would be called in.

But Dr Peter Holden, GPC negotiator, warned GPs were already the named clinicians for dying patients in the community and that it was good practice for hospital consultants to phone up the patient’s GP about potential end-of-life discussions.

‘I may well get a proper phone call from a consultant about a mutual patient who they are thinking about end-of-life care for, and we will have a mature discussion about the history and the pros and cons,’ he said. ‘That’s perfectly normal and proper.’

‘But in terms of giving out phone numbers, that is for each GP to make their own decision. You’ve got to remember there are already arrangements to provide care out of hours. It may not be physically possible to provide that care. It is for each GP to make their own decision on that and each of us has our own views.’

‘If a colleague wishes to do that, that’s within their gift. If a colleague wishes not to, that’s also within their gift and I’m not passing judgement on that. But if they think they’re going to lumber us with that, then that’s not on.’