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Strong relationship between nurse and GP can improve palliative care

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Nurses and doctors must have a trusting relationsh Nurses and doctors must have a trusting relationship

The relationship between practice nurses and GPs is crucial to ensuring that patients receive high-quality palliative care, according to evidence submitted as part of draft guidance on end-of-life care released by NICE.

The draft guidance uses evidence which cites that a trusting relationship between GPs and practice nurses as important for palliative care. It states that when this was present, the GP was happier to prescribe larger ranges of medication for the anticipatory prescribing, giving nursing staff more flexibility in the administration of pain relief. It also notes that palliative care often suffers due to a disconnect between primary care and out of hours services, which often prevents adequate anticipatory prescribing.

Professor Bill Noble, medical director at Marie Curie, said: 'With more people dying each year the demand for high quality and compassionate palliative and end of life care will only increase. However, to achieve genuine change, this will need to be embedded in continuous professional development and supported by more funding of much-needed research in the area. Without these commitments, we will never achieve the standards of other NHS practice.'

The guidance was designed after the Liverpool Care Pathway was abolished last year, after a government review identified serious failings with the protocol, particularly around the issue of when it is appropriate to begin to provide palliative care. To correct this, the draft guidance is designed to aid nurses and other healthcare professionals to identify when a patient is reaching the final phase of their life.

Sir Andrew Dillon, NICE's chief executive, said: 'While [the Liverpool Care Pathway] helped many to pass away with dignity, it became clear over time that it wasn't always used in the way it was intended.'

The guidance will also address communication between healthcare professionals and the patient and their family, which was seen as a failing in the Liverpool Care Pathway. The draft guidance recommends establishing a clear line of communication with patients, ensuring they understand which decisions are being made about their care and why, and are aware of any developments in their condition.

Sir Andrew added: 'Some families, felt that elderly relatives were placed onto the pathway without their knowledge or consent. Following a review, the pathway is no longer used.'

The consultation for the draft NICE guideline will be open until Wednesday 9 September 2015. Comments will then be reviewed before the final guideline is published for NHS use.

NICE is also developing best practice guidelines for the NHS on end of life care for infants, children and young people, and guidance on how to deliver services to improve supportive and palliative care for adults. These are expected to be published in 2016 and 2018 respectively.

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