Tuesday, 2 July 2013

Liverpool Care Pathway - BMA All The Way...? Well, Not Quite.

The BMA is quite unanimous! Well, not quite, apparently. And back in the real world, we're all still a tad underwhelmed by it all.

Now, what were they saying…?

Oh, yes -

Doctors overwhelmingly back the LCP in defiance of the fact that a government review is still under way...

So, what’s all this in the Health Service Journal, then?


Doctors acknowledge Liverpool care pathway concerns
27 June, 2013 | By The Press Association

Amid the recent “media frenzy” surrounding use of the Liverpool Care Pathway there were some “valid points”, British Medical Association representatives were told this week.

 Medics at the BMA’s annual representative meeting in Edinburgh admitted that some patients could be left on the controversial end-of-life care pathway for weeks without having their cases reviewed.

 There has been intense media scrutiny of the LCP in recent months, prompting ministers to launch an independent review that is expected to be published within a month.

 York GP Dr Mark Pickering told the conference some of the reporting had been “hysterical”, but added: “Among the media frenzy there were some valid points: relatives unaware that their family members were on the LCP.

 “Senior clinicians unaware that their patients were on the LCP. Patients left on the LCP for weeks without any review or re-evaluation.

 “This led to many patients being fearful about end-of-life care.” 

He added that financial incentives offered to hospitals to get people on the pathway - a system put in place to reward good practice - risked “a tick-box culture where clinicians may be tempted to feel that the job is done simply by getting the patient on to the LCP”.

 Dr Pickering said: “Any end-of-life care tool needs to be used well and any incentives must reward quality and not just quantity.”

 He called for better training for medics and a “culture of clear communication” between patients, their families and doctors.

 He added there must be a system of accountability to identify poor usage of the pathway.

 “The LCP may not be perfect but it can be an excellent tool and if it is used well it will continue to serve the needs of dying patients,” he said.

 Professor Baroness Ilora Finlay, a crossbench peer and palliative care doctor, said doctors needed to be aware that the LCP was not a “one-way street”, pointing out 3 per cent of patients put on it do not end up dying

.She told delegates: “The adverse media coverage has affected the care of patients who are dying because patients and their relatives have become terrified that the pathway is a one-way ticket.

“It may well be that the word pathway should be abandoned altogether. The word pathway implies that it is a one way street.

“Yet we know that when patients are managed using this type of guidance about 3 per cent of them get better, so it certainly isn’t a one-way street.”

As we were saying...

The ARM of the BMA is akin to the AGM of any Trade Union in the land. The bulk of it is politics.

And putting a spin on the reporting!!!

This is Dr. Mark Pickering writing on CMF Blogs -
The ARM is the BMA’s annual policy-making engine, and motions passed there become official policy of the organisation.
Hundreds of potential motions are submitted for the ARM around three months previously so they can be whittled down by an agenda committee to find those deemed most appropriate to debate. It is always tricky trying to judge in advance which issues will be given debating time; this is especially the case in the ethics section, where a large number of contentious issues are put forward for debate.
This year the frenzy around the LCP came to the forefront and the timing worked quite well as the government-sanctioned Independent Review of the LCP under Baroness Neuberger is considering its judgment.
Well, now we know what happened to that draft proposal...

It was 'whittled down'.
Bad Guidelines -
‘This conference:

1) Notes BMA motions in 2007 and 2012 that acknowledged the close links between the medical profession and the pharmaceutical industry and stated that these interactions can adversely influence prescribing.

2) Notes that the BMA is signatory to a document produced by the Ethical Standards in Health and Life Sciences Group called Guidance on collaboration between healthcare professionals and the pharmaceutical industry (2012) alongside the Association of the British Pharmaceutical Industry and various medical bodies.

3) Applauds the document’s aim of ‘ethics’ and ‘transparency’ but believes it is flawed for the following reasons

a) The document states that ‘medical representatives’ can be a ‘useful source of information for healthcare professionals’ and that ‘Industry has a valid and important role in the provision of medical education’.

b) The document does not acknowledge the best currently available evidence, a systematic review (Spurling et al, 2010), which shows that doctors who are exposed to information from pharmaceutical companies, such as pharmaceutical sales representative visits and attendance at pharmaceutical sponsored educational meetings, tend to prescribe more frequently, less appropriately and at higher cost than other doctors.

c) The document implies that all industry-sponsored trial data is publicly available, when this is untrue (Goldacre et al, 2013) and access to withheld information about clinical trials is the subject of a prominent on-going campaign, questions in Parliament, and at least one parliamentary select committee enquiry.

4) This conference believes

a) That the BMA should publically withdraw its support for the document

b) That the BMA should advocate for the other signatories to do the same

Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, et al. (2010) Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians’ Prescribing: A Systematic Review. PLoS Med 7(10): e1000352.

Goldacre B, Heneghan C, Godlee F, Chalmers I (2013). Missing trials briefing note. Available from http://www.alltrials.net (accessed 16 January 2013).

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