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Original poster

Trouble with illness and the district nurse

76 replies

BlatantlyOutingPost · 12/12/2015 11:30

I suffer with trigeminal neuralgia and my meds stopped working, and i've been having my worst attack ever since. Not only was it my worst attack pain wise, but it affected my vision and i've been dizzy constantly.

I have other ishoos and have to have frequent bloodwork done. If i dont get my bloods done, my repeat prescription cannot be issued (it has been refused before when i had bloods done late), and my phlebotomist has told me before that should i be too ill to go in, they can send the district nurse out. Having had to cancel two appts with her due to the attack (at this time i made an appt with my gp, which i had to wait til yesterday for) my husband asked for the district nurse to come out. This was a week ago yesterday. By this time i have already had to cancel a physio appt too.

He is told the nurse will be out monday, and will call before she comes. Monday there is no sign, i am still ill. Tuesday, no sign, i am still ill. Another physio is cancelled, two in a row meaning they want to discharge me, so dh has to convince them not to. Wednesday, no sign, i am still ill. Thursday i am still ill. But it is my dd's first nativity, the school is 2 mins walk away, so i wrap up and go in my wheelchair. While we are out (for 45 mins) guess who comes!!

Dh calls her, apologises and says where we were. As my doctors appt was tomorrow anyway, we suggest that we ask for bloods while i am there and she agrees that this sounds like an easier idea as she is now out of our area.

Drs appt yesterday, i tell her how ill i have been, she changes my meds and says that she heard all about me being out when the nurse called. I didnt make much of this at the time. She says i need to see the phleb to get my bloods done next week as the nurse doesnt like people being out when she calls - as they are supposed to be too ill to go anywhere - and gives me my repeat prescription. This is only the second time i have crossed my threshold in a few weeks (wish i kept track of dates!) and was BECAUSE of the thing that has kept me housebound.

Today i get a letter. Saying that the district nurse will not see me again and i have to get all bloods done in the drs surgery in future. As they have to see terminally ill patients who are housebound and do not have time to waste on people who are well enough to GO SHOPPING Angry

I'm livid. Was i in the wrong or have i massively interpreted something (i have asd, if that ends up neing relevant)?

OP posts:
Wolpertinger · 12/12/2015 13:01

VegetablEsoup although we don't see it, everything in the NHS costs money and has to be paid for.

So you go to hospital, get told you need a blood test. The hospital is paid to take the blood from you for that blood test. You decide to go to your GP to have it done because it's more convenient - everyone involved in your blood test at the surgery (receptionist, cleaner, practice manager, phlebotomist etc) is now working for free as the GP is not paid for that blood test.

Yes, maybe they don't mind for one blood test for someone they know is very poorly, but if everyone does it then profits are down, wages are cut, they can't offer other services that would help more people etc.

Everything in the NHS is on a financial knife edge - it's not the GPs who can't or won't take blood, it's the system that's designed to prevent them if the money for taking blood is going to someone else.

VegetablEsoup · 12/12/2015 13:06

well, everyone who needs the blood results should make/areange blood test. if seeing gp for repeat prescription for which bloods are needed they (or the nurse or someone else trained at the surgery) should do them there and then.

Wolpertinger · 12/12/2015 13:06

Blatantly Outing there might be some age to do with it with your relative. Or possibly an assessment that due to her dementia it's easier to deal with her in her own home? Or that only the DNs do this particular type of dressing not practice nurses? Or that given the frequency she needs the dressing doing it's better for the DNs to do it consistently not sometimes the DNs and sometimes the practice nurse? Or that funding for doing this sort of dressing has gone to DNs and not GPs?

It could be one or many different things so it is very hard to say. DNs will also often relax the 'totally housebound' criteria for someone terminally ill.

VegetablEsoup · 12/12/2015 13:07

maybe the nhs should be radically changed if it's not wirking for the patients as it should...

Sidge · 12/12/2015 13:11

It's also a very inefficient use of a GPs time and skills; there are a million other things that the GP could be doing in that 30-45 minute visit that ONLY the GP can do. Whereas taking blood is something that a number of other people can do, even if not in their home.

Blatantly I doubt it is an ageism thing - I don't know why your relative has a CN visit when she can get to the surgery. It may be that her dementia is such that it makes a visit to the surgery incredibly difficult in terms of her cognitive ability or the timings don't fit with the nurses' appointments - I have no idea, I'm just speculating.

But CNs will visit anyone eligible, regardless of their age; it's the eligibility criteria that are strict, not the presenting condition or age of the patient.

Wolpertinger · 12/12/2015 13:13

VegetablEsoup that would be brilliant but at a GP surgery is going to end up with at least one staff member massively underemployed.

Getting the GP to do it is tough as they only have a 10 minute slot and taking blood is a relatively low skill task (often) and you want your GP, the most expensive staff member, to be busy all the time doing things only a GP can do.

There probably isn't enough on the spot work for it to be financially viable for them to have a phlebotomist in every surgery just in case someone needs a blood test, given that most appointments don't end up with a blood test.

So you could get the nurse to do it - but you want your nurse to be busy doing asthma clinics, diabetes clinics, vaccinations etc etc not have time blocked out on the off chance someone needs a blood test. And if you squeeze people in, then all her other appointments are going to run late.

Again, it comes down to finance. It's not financially viable for GPs to have someone ready to do a blood test there and then and thats why they don't have them. While in hospital, there are loads of blood tests (and funding to take blood) so you have a phlebotomy department that people can just turn up to.

VegetablEsoup · 12/12/2015 13:14

maybe not the gp themselves, but someone in the practice (maybe even a trained receprionist)

Original poster
BlatantlyOutingPost · 12/12/2015 13:16

I'd happily learn to do it myself or have dh learn if its too fiddly for me!! Grin

OP posts:
Wolpertinger · 12/12/2015 13:17

But what are they going to do when they aren't taking blood? Each time they stop being on reception to take some blood, someone needs to cover for them.

So now you need to employ 2 receptionists, one with an enhanced salary as you've taught them additional skills, instead of one when really you only needed one and you were only funded for one in the first place.

thelouise · 12/12/2015 13:22

"it is only thanks to my dh that i can."

Well, then you can (however difficult it may be) get to the surgery. Look, in a perfect world, they would come to you but the pressures are immense. It's not about you, it's about the service. I understand why you are upset but it really isn't personal.

Puzzledandpissedoff · 12/12/2015 13:47

BlatantlyOutingPost If you've definitely lost the convenience of home visits, I'm wondering if you have a community transport scheme in your area? You'd need to register, and they can also be pretty strict about keeping the service for those genuinely unable to get out, but once accepted they often do "appointment trips" for a small fee

Original poster
BlatantlyOutingPost · 12/12/2015 13:52

Community transport wouldnt help, i have a motability car that dh drives - when i am up to going out, transport isnt the problem. It was for when i cant get out of bed. Which isn't just this one occasion btw, hence why the phleb said the DN service was available if i needed it.

OP posts:
Original poster
BlatantlyOutingPost · 12/12/2015 13:55

Sorry that should be... (Making it a bit clearer i hope)

...hence why the phleb had pointed out before that if i was ill and due bloods again, the DN service was available. (Which i now of course know was wrong for her to say)

OP posts:
Badders123 · 12/12/2015 14:06

If you can leave the house - for whatever reason - you do not need a DN visit.
Yabu.

jorahmormont · 12/12/2015 14:32

There are

Original poster
BlatantlyOutingPost · 12/12/2015 14:34

I think I will send a letter to apologise for wasting their time, but point out that - i was told it was the right thing to do by my phleb (send a copy to my drs surgery too so she knows that advice was/is incorrect) and to just inform them (and my drs in writing too) that the reason i wasnt home was slightly less frivilous than a bit of xmas shopping, if still not life or death.

Absolutely not a complaint, but i just want to ensure this isnt having any negative effect on me in future.

OP posts:
jorahmormont · 12/12/2015 14:36

Bollocks sorry.

There are quite a few instances where one medical professional says something and another says the absolute opposite.

I've been admitted to wards before after going to A&E, and told by the A&E doctors, "You need an ultrasound, they've gone home for tonight, but you can either stay in and have the scan in the morning, or come in first thing and have it". I'm terrified of hospitals, so I chose to go home with painkillers and come back in the morning.

Turn up the next morning and no-one has any record of me, no scan booked and no idea why I was there (got seen in the end, and then had to be kept in so it was a good job I went back!). I do think this is the fault of the phleb rather than the DN (but certainly not your fault).

CaspoFungin · 12/12/2015 14:40

I'm a nurse and no I don't think you are unreasonable. You've said when you asked the DNs to see you you were housebound at that time therefore it was justifiable. By the time they came out was ?Friday by which time you were capable of going to a clinic and probably were planning to do as you didn't still realise the DNs were planning to you see you. Obviously now you know how the system works you could contact the DNs and inform them you no longer need them if you are capable of leaving the house.

mayhew · 12/12/2015 14:41

In my area, District Nurse teams all have long term vacancies. And most staff are over 50. They have become an undervalued Cinderella service expected to cope with complex home care patients and an aging population.

As an HCP, I make minimal referrals because I know the pressure they are under.

CaspoFungin · 12/12/2015 14:47

I make minimal referrals because they always shout at me!

lostInTheWash · 12/12/2015 14:51

Last set of GP wouldn't take blood work - all done in the hospital department.

Seemed odd to me as previous MW would take the blood at home.

Anyway in that area there was a private service run by registered nurses that would take the bloods in your house and get them to testing place. Maybe worth asking your GP if anything like that runs in your area - even if you have to pay for it could be worth it.

Same area we had district nurse come out to us - arranged by the hospital department DH was with. It was just done - we did get rough times and days and they were very nice.

DH could leave the house - district nurse never mentioned it was a requirement that he couldn't.

In fact GP didn't do home visits - I was told by a family with terminal very frail and old ill father they wouldn't come even then. So we had to get DH there - he couldn't bend knees at all and couldn't get in cars at all rang round couldn't find a taxi that could accommodate- hired a wheel chair in end had to strap baby to me get toddler to walk and push him there and back. Bloody hard to do - GP were most unsystematic.

Wolpertinger · 12/12/2015 14:51

Caspo me too!

Original poster
BlatantlyOutingPost · 12/12/2015 14:53

Phew! It is a big relief for even a couple of people to see where i am coming from. Its quite common that my interpretation of a situation is waaay off :)

OP posts:
lostInTheWash · 12/12/2015 14:56

GP were most unsystematic - I mean sympathetic.

Op - writing to clarify the situation with GP and possible District nurse department would seem a sensible thing to do so avoid future problems seems a sensible thing to do.

CPtart · 12/12/2015 15:10

I was a district nurse for 14 years. I've lost count of the number of people who had "just popped" to the hairdressers/shops/postbox etc etc whilst supposedly being housebound enough to warrant a home visit. Everyone was supposedly more sicker, more restricted, more deserving than the rest. Pensioners quoted their age as a "right" to be visited at home. Regularly.
The ever increasing population, earlier discharge from hospital and push for terminally ill to die at home means the service is on its knees. I would never choose to die at home knowing the unrealistic promises I saw made to carers and families. As we all live longer with multiple health problems this worse only get worse. Get your DH to train in phlebotomy and he can do your bloods. It's easy.
YABU.

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