💭 A Moment for Reflection
During the height of the pandemic, general practice faced impossible pressures. Decisions were made at pace, with the best intentions — to protect patients, safeguard NHS capacity, and prepare for a wave of critical illness. But in that chaos, were RESPECT or DNACPR decisions ever recorded without full patient consent or thorough values-based discussion?
We all hope the answer is no. But are you 100% confident that no one in your team, doing what they believed was right at the time, created DNACPR forms under those exceptional circumstances — and that these decisions haven’t remained on your clinical system?
This is your opportunity to move from feeling like everything is OK — to knowing it is.
This audit offers a supportive, structured opportunity to review your records, reflect on your current processes, and ensure that every DNACPR or RESPECT entry reflects informed, person-centred, and lawful decision-making.
👉 https://club.hcqc.co.uk/c/self-audits/edit-lesson/sections/517638/lessons/2354308
In general practice, supporting people through end-of-life planning is one of the most sensitive, yet vital, responsibilities a clinical team can undertake. The RESPECT (Recommended Summary Plan for Emergency Care and Treatment) and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) forms are central tools for this process — designed to document a person’s preferences, clinical decisions, and legal rights in advance of a crisis.
This week’s audit focuses on evaluating how well your practice is managing these forms — not just whether they are filled out, but whether they reflect meaningful, lawful, and compassionate planning for patients at one of the most crucial stages of life.
Safeguarding Patient Autonomy and Rights
Every individual has the right to decide how they want to be treated — or not treated — if they become seriously unwell. In line with the Mental Capacity Act, practices are required to assess a patient’s ability to make decisions and, if capacity is lacking, make a best interest decision based on their known values.
The CQC’s ‘We’ statement on Consent to Care and Treatment sets the benchmark:
“We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.”
Failure to properly assess capacity, record consent, or involve family where appropriate can lead to serious clinical, ethical and legal risks. This audit helps ensure your documentation consistently protects those rights.
🤝 Care That Reflects the Person
The RESPECT form is not just a tick-box exercise. It is designed to reflect the individual’s goals, fears, cultural background, and definition of quality of life. As such, CQC expects practices to demonstrate this level of personalisation — reflected in the ‘Treating people as individuals’ statement:
“We treat people as individuals and make sure their care, support and treatment meets their needs and preferences.”
When completed properly, these forms can provide peace of mind to patients and their families — ensuring care decisions respect what matters most to them.
Planning for the Future with Compassion and Clarity
RESPECT and DNACPR conversations are not easy — for staff or for families. But the CQC’s ‘Planning for the future’ quality statement is clear:
“We support people to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of life.”
This means not delaying conversations unnecessarily, involving families where appropriate, and documenting these discussions in a way that can guide urgent care confidently and safely.
📋 Governance That Supports Safe and Compassionate Care
Poorly documented, outdated, or illegible DNACPR and RESPECT forms can have serious consequences — both ethically and clinically. That’s why this audit also connects with the ‘Governance, management and sustainability’ statement under the Well-led key question:
“We have clear responsibilities, roles, systems of accountability and good governance.”
Regularly reviewing, updating, and auditing these documents ensures that decisions remain accurate and reflect the patient’s current wishes and condition.
Why This Audit Is Important
By completing this audit, your practice will be able to:
- Ensure RESPECT and DNACPR documentation complies with national standards and ethical obligations
- Strengthen staff confidence in discussing and recording end-of-life preferences
- Reduce the risk of inappropriate interventions or uncoordinated care
- Show CQC inspectors that these processes are person-centred, lawful, and clinically sound
In Summary:
RESPECT and DNACPR decisions are not just clinical records — they are expressions of trust, compassion, and partnership between a patient, their family, and their care team. This audit helps ensure your practice is getting that process right, every time.
