- Over 80s and high risk groups contacted about signing “do not attempt to resuscitate” forms
- Formal guidance says GPs should “proactively complete DNAR forms… in advance of a worsening spread of disease.”
GPs are having end of life conversations with their patients because of concerns over a lack of intensive care beds during the coronavirus crisis.
Multiple GPs have told HSJ they are talking to patients who are older or in very high risk groups about signing “do not attempt to resuscitate” forms in case these patients were to go on to contract the virus.
Some practices have also sent letters to patients requesting they complete the forms, it is understood.
One leader of a primary care network, who asked not to be named, told HSJ: “Those in the severe at-risk group and those over 80 are being told they won’t necessarily be admitted to hospital if they catch coronavirus.”
Guidance issued by the Royal College of General Practitioners last week also touched on the issue, saying: “Proactively complete ReSPECT/ DNAR forms and prescribe anticipatory medications in advance of a worsening spread of disease.”
End of life conversations cover prescribing pain relief, so patients aren’t left without the appropriate medicines.
HSJ understands these conversations are also being had with people living in nursing and care homes.
Jonathan Leach, a practising GP who helped draft the guidance, told HSJ: “We have a huge role as a college [on this] as we see the volume and type of patients we should be sending into hospital and those we shouldn’t be.
“If covid-19 gets into a care home because residents are mostly vulnerable, we will see a significantly greater number over a shorter period who need this type of [palliative] care. So, part of coping with that is thinking ahead [about having these conversations].”
Dr Leach called discussing DNARs with people who are not at the end of life but are older or in a high-risk group a “grey area”. He added these decisions “need to be done on a case-by-case basis” but it was “more humane” to do it in advance.
Recent guidance issued to hospitals said palliative care conversations with a patient’s family may have to take place remotely, and skilled palliative care teams may not have the capacity to undertake all conversations themselves.
A spokeswoman for the British Medical Association, which also co-drafted the GP work prioritisation document, said: “Considering, and where possible making, specific anticipatory decisions about whether or not to attempt CPR is part of high-quality care for any person who might be approaching the end of life or who might be at risk of cardiorespiratory arrest.”
NHS England was approached for comment.
Information to HSJ , NHS England guidance, RCGP guidance