Gosport may have a negative impact on end-of-life care in general practice

Researchers from the University of Bristol have highlighted the potentially negative impact the deaths at Gosport War Memorial Hospital may have on end-of-life care delivered at home. In an editorial published in the British Journal of General Practice today [Tuesday 17 July], they call for better training for GPs and community nurses to address any anxieties they may have about prescribing and administering opioids for pain relief to terminally ill patients.

The inquiry into the deaths found that ‘the lives of over 450 people were shortened as a direct result of the pattern of prescribing and administering opioids’.

The researchers argue that concerns among the public and health professionals over the use of opioids at the end of life and myths around their role in hastening death continue, despite evidence that the appropriate use of opioids for symptom control does not shorten life.

Dr Lucy Pocock, co-author and GP Career Progression Fellow at the University of Bristol’s Centre for Academic Primary Care, said: “The patients investigated in the Gosport inquiry were not admitted for end-of-life care, and opioids were prescribed and administered to them without appropriate clinical indication. Thus, although these patients were not imminently dying, as with the Shipman case, we can expect some filtering down to the beliefs, prescribing culture, and practices of GPs.

“We believe that this highlights an urgent need for further training to address these anxieties and prevent a potential negative impact on the quality of end-of-life care being provided by generalists in the community.”

The authors suggest a move away from formal education methods to practice-based mentorship or apprenticeship models in end-of-life care education and stress the importance of good relationships with specialist palliative care services, as well as appropriate guidance.

Dr Pocock added: “Good communication with patients and their families will also be necessary, because some of the mainstream press coverage is likely to have increased lay misunderstanding and escalated concerns about the use of medication in the dying patient.”

More people are living with and dying from complex chronic illnesses and this is reflected in a growing level of need for palliative care. Between half and three quarters of the public have expressed a preference for dying at home, although less than half actually do so.

Paper:

Now Gosport: what next? (editorial) by Lucy Pocock, Karen Forbes, Colette Reid and Sarah Purdy in the British Journal of General Practice