The Liverpool Care Pathway: Independent Review

The Department of Health has now published the report on the Liverpool Care Pathway.  Both the RCGP and the BMA have released their initial responses.


Parts that stood out for me included:


“Clinicians should be required to demonstrate proficiency in caring for the dying, doctors as part of each five-year cycle of revalidation” (p.10)


“significant lack of clarity over the meaning of the term ‘end of life.’ Variously, ‘end of life’ covers the last year of life of a person with a chronic and progressive disease, the last months, the last weeks or – for the LCP – the last hours or days of life: in short, the dying process” (p.13)


“the GMC’s guidance makes clear, as a matter of good practice and respect, the clinician should explain their thinking, ensure it is understood, and offer referral for another opinion if appropriate. This is the proper process of joint decision-making.” (p.25)


“There can be no clinical justification for denying a drink to a dying patient who wants one, unless doing so would cause them distress” (p.28)


“During the relatives’ and carers’ sessions held by the Review, numerous people recounted that agreement not to attempt cardiopulmonary resuscitation had been taken by the clinical staff as a proxy for agreement to start the LCP. This is completely inappropriate” (p.32)


“a named consultant or GP should respectively take overall responsibility for the care of patients who are dying in hospital or the community” (p.37)


It will be interesting to see where we go next from here and whether or not care for dying patients will improve.  As a training scheme we will need to reflect on our approach to helping GP trainees learn about the management of dying patients.  Some thought provoking blogs from other doctors in the NHS can be found here: Dr Phil Berry “An Opaque Code: the Liverpool Care Pathway and a gap in perception”, Dr Claire Dow “Musings on the LCP” and Dr Elin Roddy “End of Life Care in hospital – a twitter conversation”.


Further resources on the LCP can be found here.


Diagnosing Dementia

In April 2013 the NHS Commissioning Board produced a new direct enhanced service with the purpose of identifying, assessing and referring patients with a possible diagnosis of dementia.  Paying GPs to undertake the new DES appears to be one of the key parts of the government’s approach to improving care for people with dementia.


It is not, however, without its critics.  The lack of evidence to support screening for dementia and the pros and cons of an early diagnosis have been highlighted in recent weeks: BJGP and an interesting analysis from Dr Shibley Rahman.


Many of you will be working in GP Practices over the coming months that are taking part in this DES and it may be worthwhile thinking about the benefits and drawbacks for us as doctors, patients and society in general.


Further resources can be found here: DoH, NICE and RCGP.  I would also like to thank Dr Samir Shah, Consultant Psychiatrist, for providing us with his top ten tips for GP trainees involved in caring for patients with dementia.


Falls Guidance

As GP trainees you will undoubtedly come across patients who experience falls and the resulting health issues.  Assessing patients who fall, or who are at risk of falls, can be complicated due to the multi-factorial causes of falls.  Hopefully the following links will give you some knowledge as to how to assess patients at risk of falls (NICE 2013), what practical steps (RCGP) you can take to reduce the risk of falls and to understand the cost of falls (Patient Safety First), both to patients and to society.