Media playback is unsupported on your device Media caption Elizabeth John said the letter was like a "death warrant from the Grim Reaper"

A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a "do not resuscitate" form.

A letter, from Llynfi Surgery, Maesteg, asks people to sign to ensure emergency services would not be called if their condition worsened due to coronavirus.

"We will not abandon you.. but we have to be frank and realistic," it said.

One patient said it left her feeling "worthless". Cwm Taf health board has issued an apology from the surgery.

Image copyright Twitter Image caption A copy of the letter was tweeted

The letter says in an "ideal situation" doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic.

"Completing a DNACPR will have several benefits," the letter said.

"1/ your GP and more importantly your friends and family will know not to call 999. 2/ scarce ambulance resources can be targeted to the young and fit who have a greater chance."

According to the Guardian newspaper, the letter was sent to a small number of patients and the staff at the surgery were apologising directly to those who had received it.

Patient Elizabeth John, who has vaginal cancer which spread to her lungs and is incurable, said the letter has caused her family "great distress".

Image caption Elizabeth John was one of the patients to receive a letter

"With treatment, my cancer can be kept at bay, so I am not ready to dig my grave even though I am a burden on society," she said.

"This letter made me feel worthless and I felt as if I had been sent a death warrant by the grim reaper."

But the 61-year-old, who has had the condition for eight years, added: "If there is a choice of a 20-year-old having a ventilator and myself having a ventilator, of course I would give that ventilator to that 20-year-old."

Cwm Taf said the advice was not a health board recommendation.

"The surgery have been made aware that the letter has caused upset to some of the patients who received it," a statement said.

"This was not their intent and they apologise for any distress caused. Staff at the surgery are speaking to those patients who received the letter to apologise directly and answer any concerns they may have."

Ogmore MP Chris Elmore, whose constituency covers Maesteg, said: "There is no getting around it, it is deeply concerning, the contents of this letter."

"The Welsh Assembly Member for Ogmore, Huw Irranca-Davies, and myself were made aware of it on Monday evening. We were straight on to the health board to find out what had gone on.

"The board then investigated and it wasn't a standard letter, so the health board spoke directly to the surgery.

"They have now asked the surgery to contact patients who received the letter to apologise and more importantly offer appropriate advice of what actually could happen in the circumstances of their particular health conditions.

"We are very concerned about the stress it has caused."

Helena Herklots, the Older People's Commissioner for Wales, said she was "shocked" the letter was even written.

"This is shameful and unacceptable," she added.

"Whilst difficult and painful decisions will need to be made in the weeks ahead, these must be taken on a case-by-case basis, through honest discussions between patients, doctors and their families that consider risks and benefits, as well as people's own wishes."