The Liberty Protection Safeguards (LPS) are due to replace the Deprivation of Liberty Safeguards. The date of implementation is not currently known. This forms part of the revised Mental Capacity Act 2005 (MCA).
The NHSE National LPS Clinical Reference Group (CRG), which includes Named GP representatives, are developing LPS processes for Primary Care. GPs may be asked for information regarding patients who may lack the capacity to make decisions about their place and type of care. Legally, a registered medical practitioner will need to supply the impairment or disorder of functioning of the mind or brain, and the mental disorder, which causes the person to lack capacity about these care decisions.
The processes being developed includes the creation of an auto-populated letter to supply the diagnosis, which will contain the relevant legal and medical wording required for the fulfilment of the LPS assessment. This letter will be available through the GP IT systems in all surgeries at the launch of the LPS.
Until the Code of Practice is published exact details are not known but this work has already been undertaken to ensure this process is as straightforward as it can be for primary care.
The possibility may arise that a GP may be requested to do a Capacity Assessment for the LPS assessment. GPs are not best placed to assess care and support needs and therefore these should be done by professionals who are specialists in this field.
When the draft Code of Practice has been published, the auto-populated letter may be amended, and further communications will be issued.
- GPs will need to support the LPS process by sharing relevant information from the medical record with the Responsible Body (Local Authority/CCG/ICB/NHS Trust).
- The GP will need to share this information either via the auto-populated letter or, if a diagnosis has not yet been made, via an assessment template.
- If a diagnosis of an impairment or disorder of the mind or brain, or mental disorder is already made and documented in the medical record, then the GP will be able to use the auto-populated letter to supply this. In this instance, a new assessment is not required, and an assessment template does not need to be completed.
- If a diagnosis of either an impairment or disorder of the mind or brain, or a mental disorder has not been made previously, then an assessment template will need to be completed, and the GP is unlikely to be able to do this. This will likely to be the role of a psychiatrist or geriatrician to establish whether the person has a mental disorder.
- GPs are not best placed to do the capacity assessments themselves, as they are not the specialists in assessing care and support needs. Rather the GP will be able to support by supplying the diagnosis to the relevant agency to enable the LPS assessment to take place.
- Potentially a GP or other clinician could undertake specialist training in assessing care and support needs to be able to contract to do the Capacity Assessments for the LPS on behalf of the relevant agency.
- If the GP feels it is appropriate, they could provide further information to support the professional doing the capacity assessment, for example knowledge of what support the patient may need to enable them to make a decision.
- If a person is receiving covert medication the GP responsible for this would need to provide evidence of both a capacity assessment and best interest decision about the medication being given covertly. NICE guidance for covert medication can be found here. Nationally we will look at providing guidance and a self-populating letter for covert medication in the coming months.
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