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GPs could be paid bonuses to help ensure patients die where they choose

Ministers back the principles behind a national scheme to give every terminally-ill patient a choice about where they die, which could mean payments to GPs who help to ensure the wishes of the dying are respected.

Every terminally-ill patient should have the right to die in the place of their choosing, with GPs paid bonuses for helping to ensure more patients are given a choice, a report to ministers has said. Care minister Norman Lamb welcomed plans to give a “national choice offer” to all dying patients by 2020, so that patients who wanted to spend their last days at home were no longer forced to die in hospital.

The review of choice in end-of-life care says more needs to be done to identify those who are likely to die soon, to ensure they are offered enough support, and that their wishes are respected. Controversially, the report calls for GPs to be paid more if patients’ preferences at the end of life are recorded, in order to ensure their care is properly co-ordinated. Under the current GP contract family doctors are already paid bonuses for identifying patients who are terminally ill. The report says consideration should be given to expanding the system, so that payments are also made for recording people’s preferences about where to die, in a bid to help ensure their wishes are respected.

Charities welcomed the principles set out in the report, which follow surveys of the bereaved which show only half felt their relatives had died in the place of their choosing. Adrienne Betteley, End of Life Care Programme Lead at Macmillan Cancer Support, said: “For far too long, the heartbreaking reality of end of life care has meant that thousands of people with cancer have been forced to die in hospital, at great expense to the NHS, when they would rather die in the comfort of their own home surrounded by their loved ones.”

But patients groups questioned why GPs needed to be paid more to ensure patients’ wishes were respected. Roger Goss, from Patient Concern, said: “It is the job of a GP to look after their patients from birth to death; why are we paying them bonuses to do the work we would expect any decent doctor to do?” Ministers welcomed the principles behind the plans, but said a full response to the proposals would come later this year.

The plans include an expansion in electronic records, so that patients wishes are shared among all those involved in a patient’s care, and can be accessed and updated by patients. The report also says that anyone approaching the end of their life should be given a named senior doctor or nurse who is responsible for their care.

Mr Lamb told the Commons: “This Government is committed to ensuring that people nearing the end of their lives get high quality, compassionate care which is focused on their individual needs and preferences.

“I welcome the Review’s advice, which proposes that a ‘national choice offer’ for everyone in need of end of life care should be in place by 2020 and sets out the actions needed to deliver this.” Phil McCarvill, head of policy and public affairs in England for Marie Curie, said: “Too many people die in hospital, simply because they aren’t offered the choice about their care or given the practical support needed to help them make informed decisions, which we think is completely unacceptable.” He said the lack of choice could leave bereaved families suffering guilt about having failed their loved ones, on top of their grief.

Claire Henry, chairman of the Choice in End of Life Care review board said: “Despite end of life care having made some great strides forward in recent years, far too many people who are dying continue to receive inadequate care that is ill-suited to their needs and wishes. Yet, as we heard time and time again during the course of the review, end of life care can be transformed by listening and acting upon what people want, in contrast to the enormous sadness, pain and regret that barriers to choice are currently causing.”

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