GPs in Wales have called for an end to the practice of senior doctors signing off end-of-life care forms.
LMC members voted in favour of a motion at the Welsh LMCs conference last week that demanded end-of-life care forms, including do not attempt resuscitation (DNAR) forms and treatment escalation plans, are completed and signed off by the clinician ‘most involved with the patient’.
Proposing the motion, North Wales LMC committee chair Dr Sara Bodey said the practice currently puts GPs at risk of legal challenge as ‘usually’ senior doctor is interpreted as GP, yet they are often not familiar with the patient in question.
She said: ‘I’ve had Macmillan nurses undertake palliative care visits have discussions around do-not-resuscitate decisions but still expect me to complete the paperwork or at least sign off their form even if I’ve never actually met the patient involved.
‘This is ridiculous enough for a binary DNAR decision but for the more complex decisions involved in treatment escalation plans it’s even more crazy but also dangerous, leaving senior clinicians, which is usually interpreted as the GP in the community, at risk of medico-legal challenge unless they repeat all the discussions in person.’
She added: ‘The move to multidisciplinary working is inevitable and in many ways welcome but there cannot be a default to still get the GP to sign off the decisions made by all the other independent practitioners.’
Supporting the motion, committee vice-chair Dr Ian Harris said: ‘We absolutely believe that getting the GP to do it is not the default position. It should be the most appropriate clinician who signs the form and has the discussion.
‘In the multidisciplinary way that we work currently, there should be no obstacle to any member of that multidisciplinary team doing it as appropriate. We’ve had situations where MacMillan nurses have said “we’ve had a chat and they don’t want to be resuscitated but I can’t sign the form”. Formitis is killing general practice at the minute and needs to be resisted.’
Motion in full
North Wales That conference believes that End of Life care forms (including DNAR and treatment escalation plans) should be completed and signed off by the clinician most involved with the patient, in partnership with the patient as appropriate. Requiring a senior doctor to countersign such forms is a nonsense in an era of multidisciplinary working and needs to stop.