GPs urged to review care of dying adults in NICE answer to Liverpool Care Pathway

GPs should prescribe patients approaching the end of their life with anticipatory medications for future problems and consider halting current treatments, according to draft NICE guidance.

NICE's draft guidance on end of life care replace the Liverpool Care Pathway (Picture: iStock)
NICE's draft guidance on end of life care replace the Liverpool Care Pathway (Picture: iStock)

The NICE draft guidance for end of life care recommends that GPs consider putting a stop to treatments that may harm patients or do not provide symptomatic benefits once they have been identified as dying, but stresses that this must take place with the patient’s informed consent.

It adds that dying patients should be prescribed anticipatory medicine ‘just in case’ to manage symptoms that could develop throughout their final days, including agitation, breathlessness and pain.

GPs should also consider whether treatment for sudden deterioration – for example due to catastrophic haemorrhage or seizure – will be needed.

The draft Care of the dying adult guidance is intended to replace the Liverpool Care Pathway, which was phased out across the NHS last year after a government-commissioned review unearthed ‘serious failings’ in its implementation.

Following concerns raised by families who claimed elderly relatives were put onto the pathway without consent, the NICE guidance emphasises that patients and their loved ones must be kept central throughout all decisions on their care.

The guidance is open for consultation until 9 September and final guidance is scheduled for release in December.

Approximately half a million people die every year in England – and in three cases out of four, their death was expected.

The draft guidance also aims to ‘help doctors and nurses identify when someone is entering their final few days of life’, with NICE acknowledging that recognising when death is imminent ‘can be challenging’.

Good practice

Dr Catherine Millington-Sanders, RCGP clinical lead for end of life, said: ‘The clear difference between this and the Liverpool Care Pathway is that this is not a "pathway" or process to be followed. This provides guidance on what good practice looks like and gives practical advice on issues that need to be considered when caring for a person in their last days of life.

‘It suggests ways in which health and social care professionals can work together in a co-ordinated and timely way and make relevant decisions, such as how to access the appropriate medications and equipment.

'It also aims to support patient choice at this important time in their life, and to enable, wherever possible, patients to be cared for and to die in their preferred place, as well as supporting their families and their carers through the experience.’

Sir Andrew Dillon, NICE chief executive, said: ‘Earlier this year, the Parliamentary and Health Service Ombudsman said that end of life care could be improved for up to 335,000 people every year in England. The guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.’

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