A recent opinion from the Commissioner highlights the importance of being realistic when discussing care plans, and the importance of ensuring competence is formally assessed when a patient is making serious decisions, such as refusing treatment.

In this case, a patient diagnosed with Huntington's disease made it very clear to her GP that she wanted to remain living at home. The GP initially made home visits, however, when the patient became increasingly reclusive and would not let the GP into the house, the only contact was through a curtain or on the phone. When the patient was eventually institutionalised it became apparent that she had been living in unsanitary conditions for an extended amount of time and could not care for herself. The GP was criticised for failing to adequately explain the realities of Huntington's disease, failing to satisfy herself that the patient was competent to make the decision to refuse services, and for continuing to prescribe for a patient she had not adequately examined. The Commissioner found that the "opportunistic contacts" between the GP and the patient did not amount to adequate care and support and were not sufficient for the GP to assume that the patient was still competent to refuse services: "It was inappropriate for [GP] to continue to assume the patient was OK just because there were no blowflies in the windows or no 'smell of death' coming from the flat". The Commissioner also found that it was inappropriate for the GP to promise that the patient could continue to live in her own home when the nature of her condition meant that she would eventually be unable to care for herself. 11HDC00647