Conversations about end of life wishes ‘crucial’ part of general practice, says RCGP

The Royal College of GPs has responded to a report by the Care Quality Commission on DNACPR decisions during the pandemic

A new report from the Care Quality Commission (CQC) has found worrying variation in people’s experiences of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the pandemic. While there were some examples of good practice, CQC also heard from people who were not properly involved in decisions, or were unaware that such an important decision about their care had been made.

Among its recommendations Protect, respect, connect – decisions about living and dying well during COVID-19 calls for the establishing of a Ministerial Oversight Group – working with partners in health and social care, local government and the voluntary sector – to take responsibility for delivering improvements in this vital and sensitive area.

Professor Martin Marshall, chair of the Royal College of GPs, said: “Conversations with patients about their wishes at or near the end of their lives are an essential part of general practice – and advance care directives, also known as advance care plans, are key to ensuring their wishes are met.

“The COVID-19 pandemic has made many people think about death and dying sooner than they may have otherwise done, and it is right that during the pandemic GPs have continued to have these conversations about what matters most for patients. The College has been clear that any decision to complete an advance care directive or Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) must involve the patient and those important to the person – and made in a sensitive, fair and equitable way, carefully considering their individual circumstances and needs.

“Having timely, personalised, and high-quality discussions with patients and those important to them about what matters most at the end-of-life is crucial. It’s important that GPs and their teams feel fully supported to have these conversations; that patients and carers are fully informed and supported to understand the meaning of these important conversations; and that GPs, patients and families are given the necessary time to have these discussions – the focus on this in today’s report is welcome.

“The College has developed guidance to support GPs and their teams to navigate their way through the ethical decisions that the COVID-19 pandemic might necessitate, in the best interests of patient care.”