Liverpool Care Pathway successor 'clarifies GP role', says RCGP

A scheme to replace the Liverpool Care Pathway will end confusion around GPs' role in end-of-life care and drive more compassionate support for patients and families, the RCGP has said.

Compassionate care: new approach will move away from protocols (Photo: Paul Starr)
Compassionate care: new approach will move away from protocols (Photo: Paul Starr)

Five new Priorities for Care, launched on Thursday, will restructure the approach to caring for people nearing the end of their life, placing greater emphasis on the wishes of the dying person and communication with their family.

The priorities were created by the Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 organisations formed in response to a 2013 report on the failings of the Liverpool Care Pathway, led by Baroness Julia Neuberger.

The alliance accepted recommendations for a named GP to take overall responsibility for the care of patients nearing the end of their lives in the community.

Dr Maureen Baker, chairwoman of the RCGP, one of the LACDP bodies, said: 'Today’s announcement should provide much-needed clarity for doctors and, most importantly, much-needed reassurance for patients and their families and carers.

'By setting out clear principles of what is expected, it should increase the confidence of doctors, nurses and other health professionals in confronting sensitive issues around end-of-life care, as well as reducing the potential for confusion or misinterpretation.'

She added that GPs had a 'central role' in end-of-life care, and that planning was crucial to achieve high quality, compassionate care.

Sensitive communication

Baroness Neuberger's report recommended phasing out the pathway after she found poor palliative care in some areas following the scheme. There were examples of a lack of tailored, personalised care, and some cases where the pathway had been treated as a tick-box exercise. Food and liquids were withheld, while relatives and carers were not involved in discussions about the care plan.

The approach to replace the Liverpool Care Pathway was set out in the LACDP report, One Chance To Get It Right.

The five new Priorities for Care state that, when it is thought a person may die within the next few days or hours:

  • This possibility is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly.

  • Sensitive communication takes place between staff and the dying person, and those identified as important to them.

  • The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.

  • The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.

  • An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion

Care and Support Minister Norman Lamb said: 'The poor care given to some people and their families on the Liverpool Care Pathway must never happen again. There are many shining examples in the NHS of excellent end-of-life care, and I am committed to making sure that care in the last few days and hours of life is tailored to the needs of each individual.'

The LACDP response also recommends the DH tracks progress on improving end-of-life care; the CQC inspects end-of-life care in all acute hospitals; and a greater emphasis on care for the dying is adopted by medical schools.

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