Dr Catherine Millington-Sanders - Channel 4 News
COMPASSION TO THE END
COVID-19 has led to more than tens of thousands of deaths across the UK. Many of those who died were living at home or in care homes in the community. “Many people have died, who before the pandemic, were not expected to die so soon”, says Catherine Millington-Sanders, RCGP and Marie Cure clinical champion for palliative and end of life care. One consequence was that access to medication to alleviate some of COVID-19’s most severe symptoms, such as extreme breathlessness, became difficult due to increased demand for strictly controlled drugs such as morphine. In response, College Chair Martin Marshall wrote to Home Secretary Priti Patel urging a temporary relaxation of rules around controlled medications and to prevent them being destroyed if they could not be used for the patient they were originally prescribed for. His letter featured on Channel 4 News and in the Financial Times. Subsequently, rules were temporarily relaxed in care homes and hospices, speeding up the process for patients who needed the drugs and easing supply issues for patients in other settings, such as their own homes. Delivering care to patients in care homes, whilst also maintaining infection control, has been a particular challenge for GPs. The College called for adequate PPE for care home staff and appropriate testing for staff and patients early on in the pandemic – and hosted a webinar for members to share best practice to deliver care in care homes, both in person and remotely, as well as producing other resources. Another consequence of increased death during the pandemic, Catherine
16 | STORIES FROM THE FRONTLINE
explains, was that for many it “brought forward the need for doctors and patients and their families to have difficult conversations about death and dying that were unplanned, given the nature of how the virus quickly affected patients. “It’s highlighted that these conversations aren’t just for the dying. We need to be more open as a society about discussing death and as GPs, about finding out what matters most to patients including advanced decisions with patients so that their wishes can be respected if they do become ill and unable to make their own decisions.” Catherine is now collecting GPs’ stories of dying, death and grief for a book aimed at helping other GPs make sense of their experiences of loss in the everyday world. The responses she has received so far, focus on learnings from GPs’ own experiences of loss and how they have applied these to their own practice. One says: “The constant challenge of medicine isn’t keeping up with the rapidly evolving science and evidence, it’s holding on to our humanity, being kind, being empathic, allowing patients and families to share their darkest thoughts and worries. Then being able to return home at the end of the day and not incorporate the suffering of others into our own lives.”
If you wish to share your own experiences with Catherine, email her at catherine.millington-sanders@ rcgp.org.uk.
Dr Victoria Tzortziou-Brown
The challenges of delivering good end of life care have never been greater for GPs.
Verifying deaths during COVID Throughout the COVID pandemic the way in which GPs have registered and managed deaths outside of a hospital changed in order to ensure that, despite unprecedented circumstances, the deceased and their families are treated with the utmost respect. Very early into the pandemic, the College became acutely aware of the challenges around remote death verification via our dedicated feedback email and members’ forum. In response the College, along with the BMA, produced guidance for the verification of expected death with the remote assistance of other workers. Influenced by the RCGP/BMA’s guidance the Department of Health and Social Care went on to update their own guidance in this area. Dr Victoria Tzortziou Brown, RCGP joint Honorary Secretary who led this work for the College, said: “Developing this guidance, as well as an e-learning module, was crucial as it ensured that the death verification process could be completed by a clinician safely without delays or potential exposure to COVID-19. It meant that at the peak of the pandemic bereaved families would not face unnecessary delays whilst GPs could continue working on the frontline minimising the spread of the virus.”
