In 23 years as a GP, says former RCGP chairman Dr Mayur Lakhani, not a single patient has asked him for help to end their life.
The Assisted Dying Bill currently being debated in the House of Lords could eventually enable GPs to intervene in this way.
As chairman of the National Council for Palliative Care (NCPC), Dr Lakhani is clear that the profession should play a central role in end-of-life care.
But helping patients end their lives, he believes, would be a step too far, and one that would wreck the relationship between patients and doctors.
General practice has changed
General practice, he says, has changed ‘beyond recognition’ since he completed his tenure as RCGP chairman in 2007.
Dr Lakhani is well placed to view the transformation from all levels. In addition to his NCPC role, he is a CCG chairman in Leicestershire and still works three days a week at the surgery he has served since qualifying as a GP.
Palliative care has long been a priority for him. ‘I always thought it was something GPs should be intimately involved with, and I felt it was important there was strong GP leadership in palliative care,’ he says.
‘I looked around at the health system and realised the current system was unsustainable. People who were dying weren’t being recognised – tens of thousands of people needed palliative care every year but were not identified and did not get it.’
Primary care should be the home of a much-improved palliative care system, with a key role for GPs, he says.
Patients prefer to die at home
GPs are well placed to take on the role, he argues. Most people coming to the end of their lives die in hospital, but the vast majority say they would rather die at home.
The leading causes are frailty, old age and chronic conditions – people in these groups are often well known to their GPs.
The biggest obstacle, says Dr Lakhani, is the ‘taboo’ around death and dying, which can make it a difficult topic for doctors and patients to broach.
He recommends the ‘surprise question’ as an easy way to tell when to raise the subject. GPs need to ask themselves whether they would be ‘surprised if this patient were to die in the next 12 months’. He stresses that if the answer is no, ‘please don’t leave it to start a conversation [about end-of-life care]’.
The GP role should include identifying the patients who need the care, diagnosis, care planning and support for families and patients during their last few days, he adds.
Around 500,000 people die in Britain each year – one every minute. He says there is huge ‘unmet need’ for palliative care, and practices should expect around 1% of their list to require this help each year.
Improving quality of life
Dr Lakhani says that many patients approaching the end of their life do not realise what care and support is available to them through palliative care, which could dramatically improve their quality of life.
‘I find that a lot of people don’t know how much can be done in palliative care, so they have fears that are unfounded. They have fears about pain control, about not getting support, that they’ll choke and stuff like that. And we try and reassure them to say with clinical palliative care we should be able to support you tremendously.’
He warns against the implementation of the Assisted Dying Bill, currently being debated in the House of Lords, which would be a ‘public safety issue’ and could undermine doctor-patient relationships.
Although Dr Lakhani has ‘not had a single request’ to assist a patient’s death, many have requested palliative care.
Allowing doctors to help patients to die could risk making such patients feel ‘guilty’ about being a ‘burden to their family’, he warns.
‘My personal view as a GP is I would be very worried if the law was passed. It would affect the doctor-patient relationship, and so, as a doctor, I do not feel that it should be anything to do with me, and it should not be part of my palliative care offer.’
Tough time for GPs
Next year, Dr Lakhani’s role as chairman of the National Council for Palliative Care will come to an end, as he reaches the maximum limit of seven years in the post.
‘It was a great privilege, to have been chair of the college and now the national council,’ he says.
‘I'm thinking about future challenges and opportunities. I feel there's a lot to do – I don’t feel like my work is quite done.’
Dr Lakhani admits that he can’t remember a time when ‘things were looking so difficult for GPs’.
But he remains convinced this is still a ‘great time to be a GP’. He explains: We’ve got great support, we have appraisal, good IT systems – and just think of all the things we can do and diagnose.
‘I'm proud of what GPs are doing and I want to help them and support them to get to a better place, especially the younger generation - to get more people interested. It’s the best career, I think, and we have to make the case for that very strongly.’