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Tick-boxing has ‘no place’ in the unplanned admissions DES, says NHS England



There is ‘no place’ for GPs or nurses to adopt an ‘insensitive tick-box approach’ in the completion of care plans for the unplanned admissions DES, NHS England has said, in response to the recent controversy over a ‘do not resucitate’ question.

It told Pulse that the approach had led to ‘disturbing’ media reports and it was ‘fundamental’ that doctors communicate with patients in a ‘compassionate and sensitive way’.

The comments come after NHS England announced yesterday that it would be reviewing the care plan template in response to claims in the Daily Mail that care coordinators for the DES were ‘callously’ asking patients to sign DNRs as part of some of the questions on the form.

It also comes only a few weeks after GP leaders warned that a lack of leniency from NHS England in meeting the DES requirements would mean GPs would end up with no option but to run it as a ‘tick box exercise.’

NHS England did not comment on whether practices that have used the template for the completion of care plans so far should stop using it until the review was completed, but said that the template is just an aide for completing the DES and practices are entirely free to develop their own form.

It said it will also be reviewing the guidance around the DES with the BMA to ensure those completing care plans were aware that they should use ‘professional judgement’ on whether its appropriate to discuss end of life care with a particular patient.

An NHS England spokesperson said: ‘Communicating with patients in a compassionate and sensitive way is fundamental to being a doctor, nurse or any health professional.’

‘This comes down to professional judgement and there is no place for the kind of insensitive ‘tick box’ approach to such conversations as highlighted in the disturbing accounts in the media.’

‘We will be reviewing the guidance with the British Medical Association, to ensure that there is no room for misinterpretation in how it should be used.’