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GPs pushed to sign DNRs

Exclusive Health visitors, social care workers and pharmacists are being asked to discuss ‘do not resuscitate' (DNR) forms with patients in some parts of the country, a Pulse investigation reveals.

Our findings expose a wide disparity in approaches to DNR paperwork, with some involving junior staff, while others insist such conversations should be the preserve of senior doctors.

Out-of-hours GPs are also coming under pressure to sign DNR forms even when not in possession of medical records.

New figures from the Medical Defence Union reveal a 50% rise in the number of legal cases opened relating to DNR forms, from 13 a year in 2007-8, to 20 a year in 2009 and 2010.

Among 70 primary care organisations and SHAs, a third had introduced standardised DNR forms in the past year, with 44% now having one. Of 23 organisations to provide details on who was expected to discuss DNR paperwork with patients, 30% included health visitors, 26% social care workers, 22% healthcare assistants and 17% pharmacists. All said practice-based GPs and hospital doctors were expected to discuss forms, 92% out-of-hours doctors and 75% community or specialist nurses. But a Pulse survey of 290 GPs found 19% had been asked to sign a DNR form in circumstances they regarded as inappropriate, while only 23% said guidance on DNR forms was clear.

Dr Fay Wilson, a GP in Birmingham and group medical director of the BADGER out-of hours group, warned out-of-hours doctors were sometimes expected to sign forms ‘in a vacuum' without knowing patients or having access to records.

Dr Duncan Walling, medical director of Wessex LMCs, said GPs had initially been expected to discuss DNR forms with all patients in care homes after their introduction: ‘That's not appropriate use of GP time or appropriate for the patients.'