CQC review finds evidence of ‘inappropriate’ DNR decisions during pandemic

The CQC has found that GPs made inappropriate advanced care decisions due to confusion and pressure at the start of the coronavirus pandemic.

An interim report published today by the CQC stated that there was evidence of ‘unacceptable and inappropriate’ DNR orders – also known as DNACPR orders – during the pandemic.

The DNRs were incorrectly combined with other critical care assessments and applied to specific groups of patients, the report said.

The CQC launched its investigation into DNR decisions in October, following concerns that elderly and vulnerable people were subject to such decisions without their consent or informed choice earlier on in the Covid-19 pandemic.

The interim findings of the review provide the foundations for further investigations, which will take place in seven CGCs across the country, focussing on the experiences of the groups of patients disproportionately affected by this issue.

Dr Rosie Benneyworth, CQC chief inspector of primary medical services, said: ‘It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people.’

The report references research interviews with stakeholders such as charities representing vulnerable groups or interviews with individuals with lived experiences of DNRs. Interviewees refer to some GPs ‘putting blanket DNACPRs on care homes’ and ‘some care homes and learning disability services receiving instructions from GPs to place blanket DNACPRs on people in their care.’

Dr Benneyworth warned: ‘We have also highlighted the fact that it is possible in some cases that inappropriate DNACPRs remain in place – and made it clear that all care providers have a responsibility to assure themselves that any DNACPR decisions have been made appropriately, in discussion with the person and in line with legal requirements.’

NHS England have stated that GPs should ‘encourage’ the ‘most vulnerable’ patients to ‘discuss their individual wishes and concerns regarding their treatment preferences should they develop Covid-19 symptoms and record those preferences in an advance care plan.’

The guidance followed a CCG notice to hundreds of GP practices in North West London advising them to tell the relatives of care home patients who lack capacity that ‘difficult decisions’ will need to be made around admitting these patients to hospital.

The CQC will publish a national report in February 2021, setting out the finding from the completed review with the aim being to outline any known changes to the use of DNACPRs in response to the pandemic and describing good practice when issuing the orders.