Pulse reported that the RCGP thinks GPs are avoiding the Liverpool Care Pathway because of ‘adverse publicity’, but I think the RCGP has got this the wrong way round.
GPs have stopped (or never started) using the LCP and other pathways for four main reasons: it implies a ‘one-size-fits-all’ programme, leading to certain death without individual choice; clinicians can sometimes follow it to the letter and fail to show flexibility; there is a feeling among some GPs that incentivising us to put people on the pathway with a ‘target number’ is inappropriate and insensitive; and it can be difficult to be sure that a patient is in the last six to 12 months of their life, but putting them on an ‘end-of-life’ ‘pathway’ makes it a certainty that will be acted upon.
The LCP can be a useful guide for those who are inexperienced or lack the experience to provide the best care, but it is these genuine concerns that lie behind the profession’s caution, not GPs being influenced by the press.
Dr Alison Lloyd, Twickenham
