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NHS England to review unplanned admissions care plan following ‘do not resuscitate’ controversy

NHS England is reviewing the care plan template for the unplanned admissions DES following the recent controversy over a ‘do not resucitate’ question.

The forms would be reviewed in light of ‘poor patient experiences’ reported in the media, NHS England told Pulse, after the Daily Mail alleged on Tuesday that care coordinators for the DES were ‘callously’ asking patients to sign DNRs as part of some of the questions on the form.

The questions are included towards the end of the template form, developed by NHS Employers, NHS England and the BMA, and titled ‘Other relevant information (‘if appropriate)’.

The form states ‘[Was] emergency care and treatment discussed’ – adding: ‘if yes, please specify and outcome e.g: cardiopulmonary resuscitation – has the patient agreed a DNR or what treatment should be given if seizures last longer than x do y etc.’

Pulse revealed earlier this month that palliative care leaders were warning the unplanned admissions DES could cause harm to elderly patients if GPs were forced to treat it as a tick-box exercise.

This came after Pulse revealed NHS England issued strict guidance to its area teams that they should offer no leniency over DES deadlines, including completion of the 2% of care plans, creating fears GPs would be forced to ‘cut corners’.

Pulse understand that any reviews of guidance will have to be done in conjunction with the GPC and NHS Employers, and is awaiting further information from NHS England on future use of the form.

NHS England’s chief nursing officer Jane Cummings said: ‘There is one question on the form relating to emergency care and treatment and it mentions resuscitation as a possible discussion point.’

’Clearly if this conversation is appropriate for the patient, and as the form suggests it might not be, then it should be handled with great care.’

‘Just as it is important for nurses to listen to patients, it is important for the NHS to listen to patients and patient organisations.’

‘We will review the form again, with patients and clinical staff, in the light of the poor experiences described in the media and make any changes that are needed.’

The story broke when health commentator Roy Lilley revealed that his mother’s care coordinator, a district nurse who they hadn’t previously met, asked the questions while discussing the care plan. There were also reports of the questions on DNR being asked over the phone.

GPC deputy chair Dr Richard Vautrey said that the GPC had published its own guidance for GPs but explained that NHS England’s overly rigid interpretation meant these results were inevitable.

‘This is a classic example how an idea has been taken by over-officious managers, and turned into something that wasn’t intended. It’s these perverse outcomes that we see as a result of that.’

So I think whilst the review that NHS England has indicated is welcome, I think they need to go further than simply looking at this particular tick box, they need to look at the whole thing and ensure that practices do have genuine flexibility to deliver this in a way that is meaningful.’

Dr Vautrey added that: ‘What practices need to ensure, is that those who are acting on their behalf interpreting and developing care plans and discussing with patients, use their clinical judgement.‘

‘It comes down to common sense really, and being willing to stand up to those who want to over scrutinise this.’