GPs urged to find the 1% of patients with a year to live

GPs have been urged to identify the 1% of patients on their practice lists who are likely to die that year and discuss end of life care.

Around 1% of the population dies each year and the ‘Find Your 1%’ campaign aims to get GPs talking to patients likely to die within the year ‘as early as possible’ about wishes for palliative care.

But Northumberland LMC secretary Dr Jane Lothian, who is involved with local palliative care work, questioned the ethics of the ‘somewhat arbitrary’ selection of patients.

The Dying Matters Coalition campaign is part of the government’s Quality, Innovation, Productivity and Prevention (QIPP) agenda.

It seeks to persuade GPs to discuss end-of-life care with patients who are likely to die in the next 6-12 months, in order to increase the number of people dying in their usual place of residence.

Dr Lothian agreed that GPs should be ‘proactive’ about discussing palliative care. ‘It’s a skill of any primary care doctor, practice or district nurse,’ she said. ‘Usually it's about allowing people space to have that discussion.’

But she said patients often feel ‘duty-bound’ to simply follow the doctor’s lead without knowing they have choices, such as where they would like to die.

She added that it would be ‘extremely difficult’ for GPs to predict who was going to die in the coming year, other than those already dying. ‘Picking out people in a somewhat arbitrary way is very difficult.’

Targeting a proportion of the practice list could be ‘unethical’ and in some cases that conversation needs to happen several years before the patient is near death, she said.

The third annual report of the end-of-life care strategy published last month said more needed to be done to increase the number of people dying in their home or care home.

Last year, a report from the National End of Life Intelligence Network found that, although most people want to die at home, just 19% do.

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