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Editorial Graham Scott EDITOR

@NSeditor

Let’s start again with that emergency form What would you do for £2.87? It’s barely enough for a fancy coffee on the high street or for a sandwich from the canteen, should you be lucky enough to have a lunch break. But it is the princely sum that GPs receive for each patient they sign up to a scheme designed to avoid unplanned hospital admissions. Why GPs should require such a financial incentive is mystifying. If it is good for the patient and for the health service to keep someone out of hospital, then surely our family doctors would do what it takes without monetary reward. If only.

PATIENTS FEEL UNDER PRESSURE TO SIGN AGAINST THEIR WISHES

Like many similar schemes in general practice, doctors are being paid for work that is undertaken by nurses. In this case, this includes home visits to those on their lists who are identified as at high risk of unplanned admission. At these visits the community nurse is armed with a form to complete, much of which seeks the same old information – name, address, NHS number, next of kin, known allergies, and so on. But halfway down the second page comes a question that is as badly worded as it is controversial: ‘Has the patient agreed a DNR or what treatment should be given if seizures last longer than x do y etc.’ The question is supposed to act as a prompt for a discussion on how hospital staff should respond if the patient is admitted in an emergency. According to anecdotal reports in the media, the reality has been somewhat different, with patients feeling under pressure to sign a DNR order against their wishes during appointments that span 15 minutes at most. England’s chief nursing officer Jane Cummings responded appropriately and promptly by ordering a review of the form and its wording. There also needs to be a review of when, where and how such discussions take place, as well as their legal status. And, crucially, the nurses involved must be allocated an appropriate amount of time to discuss patients’ wishes. See news page 7 Air your views on

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www.nursing-standard.co.uk august 27 :: vol 28 no 52 :: 2014 3

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Let's start again with that emergency form.

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