Disgusted with the GP.

[Daisymae15]

This is not a bashing the NHS thread we are so angry with the GP.

My Mil 92 is in a nursing home last Thursday she had a minor stroke the home called the GP and all she has done is send aspirin, wouldn't visit.
Yesterday she had a fall, banged her head, shoulder and back. Not injured enough to call an ambulance.
The GP was called yesterday and was supposed to phone, as of 7pm tonight she still hasn't rung. When WE phoned the surgery told that she is on the list to be called.
The home are frustrated at not being able to give anything stronger than paracetamol. We are frustrated because of covid we are not allowed to visit.
(Someone tested positive on Saturday so they have gone back in lockdown)
We feel as though the GP is hoping she dies so she doesn't need to bother. DH has spoken to the home and they have said that they are worried about her, she is in a lot of pain, very depressed and not even got dressed today. Last night she slept in a chair as she couldn't lie down.

As I have said I'm not bashing the NHS as in the last year I have had breast cancer and my treatment has been first class.(Not under the same surgery)
We can't change surgeries as each home in town has an allocated practice.

Is covid to blame or is it possible that she is a shit GP.

The DNR is irrelevant, that doesnt mean whe cannot have scans, painkillers, an operation if needed. Poor woman.

[quote VaccineSticker]@Daisymae15 why do they have a DNR in place? Honestly I’m in absolute and utter shock![/quote]
What's wrong with a DNR? It's absolutely not a Do Not Treat - it's an undertaking to not break their ribs on a 20% chance that someone nearing the natural end of their life can be brought back to suffer a bit longer.

@Daisymae15

DH is on the phone to the home now. Just to say all the residents have a DNR in place.

Even if they do, that doesn't mean that people should be left to suffer in pain and/or distress.

I'm appalled. They should have called an ambulance for a TIA anyway.

@EbbandTheWanderingHearts

If your MIL had a TIA the nursing home absolutely should have called an ambulance. I'd be reporting them to the CQC. Your poor MIL.

Also this. The Home seems confused about their responsibilities.

As others have said DNR does not mean she isn't entitled to appropriate medical treatment like an ambulance or proper pain relief.

Did your DH realise she had a DNR in place? Did he ever sign a DNR form?

@Daisymae15

DH is on the phone to the home now. Just to say all the residents have a DNR in place.

This doesnt stop an ambulance being called

If she fell and is in enough pain not to be able to lie down then she needs to be checked over asap. She could have broken a hip for example.

That is awful care from the gp and the home. I work in a&e and cannot think of a single care home in the area who wouldn't phone an ambulance. She's hit her head and is on aspirin. That is a flag for immediate transfer to hospital for a scan to check for bleeding on the brain. She definitely needs to be seen especially as she has new neurology (vacant stares, not as mobile)

DNR does not mean do not treat. The care home sounds appalling.

No advice from me, the other posters have that covered. I just want to send my well wishes to you, your MIL and your family. Terrible she's being left to suffer.

Like you I am sick of the service provided by GP surgeries they seem to have embraced the phone consultations. I have no problem with this in principle but think that people in general know whether or not they can be dealt with over the phone. As a consequence you can’t see a doctor without having a phone consultation and you can’t get through on the phone because it’s always engaged.

@BastardMonkfish

As others have said DNR does not mean she isn't entitled to appropriate medical treatment like an ambulance or proper pain relief.

Did your DH realise she had a DNR in place? Did he ever sign a DNR form?

Maybe MIL signed it herself?

Poor woman, stuck somewhere without access to sufficient pain relief, that really is shocking, its not as though she is marooned on an Island.

Care home is at fault here

The treatment of geriatrics in this country is appalling.
I've seen it through both 'sides'. As a HCP and the child of elderly parents.
It makes me so fucking furious

Good luck OP. I'm afraid that you and DH will need to be her champions.

The GP and the home are at fault.

DNR means only that if she had a cardiac arrest she would not be resuscitated not that she should be denied all other care!!

Get her to a hospital even if you call the ambulance and send it to her home.

my mum had a DNR but still got treated for a stroke .

That's bad an ambulance should have been called .

@Daisymae15, please raise a safeguarding alert with your local authority against the nursing home. They have an overall responsibility of care for your Nan. She shouldn’t be left in pain like that regardless of what they’re saying.

You can also give feedback on care to cqc. They will be keen to hear what’s happening, especially in regard to the blanket approach to the DNR. Happy to have a private discussion with you! I really hope your nan is ok.

You should be angry at the nursing home not the gp! They sound absolutely negligent!

None of it sounds great. But I agree an ambulance should have been called if they were concerned about the fall. And the GP shoukd have been quicker of the mark with a prescription if she was in so much pain.

My SIL is a care home manager. It is the responsibility of the care home to act in the best interests of their clients and make sure they get the appropriate medical care. Speak to the care home manager (sil is always on call) if you are concerned or feel she isnt getting the right care.

Nursing home should have called an ambulance. DNR just means no resuscitation (which is almost certainly the correct decision), but if does not mean no treatment.

God I hate how we treat the elderly. This is not all on the GP - they’re not there to see people who’ve fallen over and injured themselves. The home should have called an ambulance, and if she is in too much pain to get around they should still call an ambulance. Is there anything to stop you just turning up and refusing to leave until you’ve seen her (and calling 999 yourself or just driving her to AE?)

Some real misconceptions about DNACPR forms.

In care homes now all residents should have a ReSPECT form completed on admission. Some are completed in hospitals, some by GPs. Certainly every resident in a nursing home should have one.

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. Such emergencies may include death or cardiac arrest, but are not limited to those events. The process is intended to respect both patient preferences and clinical judgement. The agreed realistic clinical recommendations that are recorded include a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stop.

DNACPR does not require consent. It is a clinical decision made in discussion with patients or LPA. You cannot consent to treatment that isn’t offered. To attempt resuscitation on a very elderly person in a nursing home would be cruel.

The idea of a ReSPECT form is to allow people to remain in their usual home. Transfer to hospital is rarely in people’s best interest by the time they need a nursing home.

It is entirely possible they are very good GP who has had the conversation with your mother in law. What would you expect from transfer? A long wait in a busy confusing environment, on a trolley? Far better to remain at home. What treatment would you want for a TIA on someone of her age and frailty?

Your GP can prescribe painkillers and the home should have stock supplies, so perfectly able to give without a pharmacy dispensing personal ones. Many Many GPs are working through calls at 7pm.

A resident in a nursing home isn’t going to be a top priority because they have professional oversight already. The elderly person at home would take precedence. The person with chest pain would take precedence.

[quote WeatherwaxLives]Why do all the residents have a DNR?!

Is this from earlier in covid when elderly and disabled people in care were subject to blanket DNRs?

Obviously if MIL has chosen to have a DNR then that's her right, but if she hasn't consented to it then it's absolutely not OK.

I find it unlikely that every single resident has independently consented to a DNR.

www.google.com/amp/s/amp.theguardian.com/world/2020/oct/12/inquiry-begins-into-blanket-use-in-england-of-covid-do-not-resuscitate-orders[/quote]
Blanket DNRs are wrong of course. But a DNR is the decision of a doctor - it is not something that requires a patient to consent to. A DNR is our in place when resuscitating a patient would leave them to suffer. With elderly patients often the rib cage is broken and it is so inhumane. Much better to allow someone at the end of their life to pass peacefully than to have to spend their last days suffering and in pain.

However, that isn't relevant to this situation. The lady needs to be assessed in hospital. She has possibly fallen due to the TIA/stroke. The home needs to call and ambulance now. She can't be left so uncomfortable and in pain over night.