A GP Practice failed to discuss the implications of stopping medication for a dying patient

What happened

Mrs W's husband was receiving palliative care for pancreatic cancer from the Trust and the Practice. Mrs W complained that the GP at the Practice failed to discuss the implications of stopping Mr W's tinzaparin injections. A few days before Mr W's death, the GP was asked by a nurse caring for Mr W if the tinzaparin injections should be stopped. He told the nurse to ask Mrs W, without explaining what would happen to Mr W if he no longer received this medication. Mrs W also complained that in the moments after her husband's death, a district nurse entered the house and proceeded to remove the batteries from the syringe driver so as to prevent it from bleeping, which was inconsiderate to Mrs W's grieving.

What we found

We partly upheld this complaint. The Practice failed to follow General Medical Council (GMC) guidance on end of life care because the GP should have assessed Mr W's condition, taking into account his medical history and Mr and Mrs W's knowledge and experience of his illness. The GP should have used his specialist knowledge, experience and clinical judgment, together with Mr and Mrs W's views, to identify which investigations or treatments were clinically appropriate and likely to benefit Mr W. The GP did not do this and this was a failing of the Practice that caused undue distress and confusion at an exceptionally difficult time.

In the minutes following Mr W's death, a district nurse and a health care assistant visited. This caused Mrs W great distress because they appeared insensitive and uncaring about her husband's death.

When the Trust received Mrs W's complaint, its locality manager visited Mrs W to discuss the issues raised. Following an investigation, the Trust sent a written response the next month in which it passed on apologies from the district nurse and the health care assistant involved. They explained that they had reflected on the comments and feelings and recognised that the situation was very sensitive. They explained that it was not their intention to be uncaring and insensitive. The Trust acknowledged that the district nurse should not have removed the batteries from the syringe driver very soon after Mr W's death.

In its investigation, the Trust confirmed that the district nurse and the health care assistant had reviewed their communication approach, with other members of the team, for future visits. The Trust also spoke to the district nurse to confirm the Trust's syringe pump policy. The actions taken by the Trust were reasonable and demonstrated it had learnt lessons from the complaint.

Putting it right

We were not satisfied that the Practice had done enough to stop a situation like this happening again. At our request the Practice apologised to Mrs W for the impact these failings had on her. It also agreed to improve its palliative care procedures to take into account the GMC guidance.