Put 1 in 100 patients on death list, GPS told
Frailest to be asked to choose ‘end-of-life’ care
GPs have been asked to select one in every 100 of their patients to go on a list of those likely to die over the next 12 months.
The patients will be singled out for ‘end-of-life care’, potentially saving the NHS more than £1billion a year.
The listed patients may be asked to say where they would prefer to die and should be told they can draw up a ‘living will’ by which they can instruct doctors to withdraw life- saving treatment if they become incapacitated in hospital.
The ‘toolkit’ giving doctors and health and social workers new guidance on how to select candidates was launched by Liberal Democrat Care Minister Norman Lamb at a conference on end-of-life care.
It states that ‘approximately 1 per cent of people on a GP’s list [of all patients] will die each year – this equates to an average of 20 deaths a year. Around 70 per cent to 80 per cent of all deaths are likely to benefit from planned end-of-life care.’
It said: ‘Have your local practices identified the 1 per cent of their practice population who may be likely to die in the next year?’
Doctors are told to pick out such patients during routine consultations that show ‘indicators of frailty and deterioration’ and are told that ‘older people are a priority to consider’.
They are also told to use feedback from district nurses or hospital consultants, while patients in care homes should be ‘actively considered for your register’, the advice states.
Information for GPs on what happens to such patients said they would be ‘less likely to be subject to treatments of limited clinical value’.
It added that a quarter of all hospital beds are occupied by dying people and said that four in ten have no medical need to be there.
If each had one less emergency admission into hospital in their last weeks and months, that would save the NHS £1.35billion a year, the material said.
The advice tells doctors: ‘After several years of falling,
‘Comfortable and dignified’
the death rate is about to increase again as the baby boomers reach old age. This is a bad situation, which is going to get worse unless we act now.’
The register plan emerged amid a growing controversy over the Liverpool Care Pathway (LCP), the method adopted by hospitals with the aim of easing the last hours of those judged to be dying.
Health ministers yesterday endorsed the LCP – which can involve sedation and the withdrawal of food, fluids and lifesaving treatment from patients, – releasing a report which said it was ‘best practice’ and recommended by the NHS.
The Health Department’s latest report also backs the campaign for GP ‘death lists’.
Over the past week, some families have told the Daily Mail that they believe their loved ones were wrongly put on the LCP by hospitals when they were not in fact dying.
One senior NHS consultant, Professor Patrick Pullicino, has criticised it as a ‘self-fulfilling prophecy’.
But Mr Lamb told the conference yesterday that he was delighted with the latest toolkit, saying that while ‘end- of-life care in hospital is often not as good as it could be’, it should be ‘as comfortable and dignified as we can possibly make it’.