The latest crisis concerning UK end-of-life care arose in June 2018, with the publication of the Jones inquiry into hundreds of premature deaths at Gosport War Memorial Hospital in the 1990s. The inquiry concluded that misuse of diamorphine and syringe drivers, often following the clinical instruction ‘please make comfortable’, led to the excess deaths: a scandal which is hard to overstate.
Unfortunately, this is but one of many NHS scandals highlighting patient safety failures at multiple levels, with concerns raised about culture, insufficient challenging and investigation of poor practice, and poor support of whistle-blowers. Pocock et al’s BJGP editorial considers whether this was the result of a rogue clinician or systemic failures, whilst assessing the effect on palliative care provision, with the case of GP Harold Shipman still in recent memory.
In their BJGP article, Dr Daniel Knights, Dr Felicity Knights (both University of Cambridge graduates) and Dr Stephen Barclay, Senior Lecturer at the Primary Care Unit, explain the complexity surrounding opioid prescribing in palliative and end-of-life care, with its repercussions on both public and political discourse in the UK and further afield. They also provide guidance for GPs on opioid prescribing in this BJGPLife companion piece.
Opioids are essential for the palliation of pain in advanced disease, and when appropriately prescribed do not hasten death nor cause addiction: outside of that context, the risks of addiction and premature death are considerable.”
– Dr Stephen Barclay, Senior Lecturer
The authors suggest that clinicians should ensure that only patients who need opioids receive them. They emphasise that those who would clinically benefit should not have these essential analgesics withheld due to patient, relative or professional anxiety – a significant concern following the often alarmist and unclear coverage of the events at Gosport in the 1990’s.
Read the article in full in the BJGP. Daniel Knights, Locum Doctor, Princess Alice Hospice, Esher, Felicity Knights, General Practice Specialty Trainee, Kingston & Roehampton Training Scheme and Stephen Barclay, University Senior Lecturer in General Practice and Palliative Care, Primary Care Unit, University of Cambridge
Contact: Lucy Lloyd, Communications manager, Primary Care Unit, University of Cambridge