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.

@LemonRoses

If a ReSPECT form has determined the ceiling of care, an ambulance will most likely not transfer to hospital for most things. A home calling an ambulance to transport a frail elderly patient against a clinical decision isn’t acting in their best interests. They are not providing good care by so doing.

Most nursing home residents would be offered a natural and dignified death rather than a ham fisted resuscitation attempt and inappropriate transfer only to die on the journey or with strangers in a busy accident department. Resuscitation on a frail 90 year old is futile.

It certainly doesn't sound from what the OP says that MIL is particularly frail or nearing end of life. Clearly if she's in a nursing home her health isn't brilliant but she needed and should have been given medical treatment. She should at least have proper pain relief and I doubt what she's getting tomorrow will cut it.

@Looubylou

Lemon Roses - it's a nursing home not a care home. There has to be a RN on duty. (Though I still question the decision making in this scenario, also the GP stating the covid status of another patient as a reason not to visit someone who needs assessment is negligent in my opinion).

No. In law it doesn’t actually need an RN. It needs sufficient suitably qualified staff to meet people’s assessed needs. Most would, of course require at least one RN but that’s not because of the name of the home. It’s because of people’s needs.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 18 Regulation says simply “Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part.”.

@lostfrequencies

It was a condition to get into the care home to have a DNAR in place!? What the actual fuck?

Private nursing homes can set their own terms and conditions. To hazard a guess (I could be way off!!!) but they possibly implemented the DNR requirement for admission in response to covid (CPR being an aerosol generating procedure) to minimise risk to staff and other residents (and their liability!!)

@LemonRoses

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.

This. Absolutely correct. Lying on a trolley in a and e should be the last resort. A nursing home should be well equipped to deal with a TIA.

My mum had a fall in her care (not nursing) home recently. They called an ambulance as it’s their policy for all falls. The paramedic phoned me at home to say she’d fallen and that they’d done all the checks and she seemed ok - just a bit sore and bruised. They said they could take her in but a and e was overflowing and she’d get better care where she was. I didn’t hesitate to agree that she should stay put.

I’m curious as to what treatment people would want the poor woman to have?
Surgery for a partially blocked carotid and a stay in a HDU unit?
Anti hypertensives that increase her risk of falls?

What treatment are people thinking she might benefit from?

You don’t need to go to hospital for pain killers or good nursing care. You are safer in your usual home. People in nursing homes have a typical life expectancy of under two years from admission. They are approaching life’s end and recognition of this allows for proper holistic palliative care.

Private nursing homes can set their own terms and conditions. Only in respect of financial arrangements and contractual obligations. The way care and treatment are provided are very strictly controlled through regulation and commissioning.

Blood thinner + head injury = 999.

Anything less is negligence unless for whatever reason she has decided against any emergency medical treatment for injury/accident which is rare in my experience.

What treatment are people thinking she might benefit from?

Pain relief , preferably sooner than in 12 hours time. I am fairly sure that sufficent pain relief is a vital element of proper holistic palliative care.

We feel as though the GP is hoping she dies so she doesn't need to bother.

Please don’t think that. It really won’t be the case. Far from it.

When I was battling with the staff in A and E a few years ago. OH had complications post surgery a few days after he got home. I drove him to the hospital because GP refused to see him. Eventually one nurse gave him a morphine jab

I thought about filming and phoning a journalist then and there. Everyone ignored my pleas to just triage him. I was told later I should have called an ambulance instead of driving there

She needs pain relief now. Not in the morning. Hopefully the ambulance can help.

The home sound awful too. Who diagnosed the "small stroke"? That alone is a 999 call according to the NHS website guidance.

Who has agreed to the blanket DNR? Surely the next of kin should have been involved.

The nursing home sounds terrible, they are negligent, and as for having a DNR as a condition for entering the home well words fail me.

The home has covid they might be leery about admitting her.

Nurses can do their own assessments on residents and depending on the severity of the fall and symptoms of the TIA they may decide to call an ambulance or GP or decide that they can treat and monitor within the home.

I would imagine the home and the GP do not want to send an elderly person to hospital unnecessarily which could cause lots of distress and put her at risk of further illness and infection.

However, I would say that it is not ok that she is in pain. The GP and nursing home should be acting on this and ensuring that they have done their best to ensure she is comfortable without delay. This could partly the GP's lack of action, but also poor communication from the nursing staff at the home.

@frumpety

What treatment are people thinking she might benefit from?

Pain relief , preferably sooner than in 12 hours time. I am fairly sure that sufficent pain relief is a vital element of proper holistic palliative care.

Absolutely. You don’t need an ambulance to get pain relief though.

From a large persons reading this, the posts that stand out to me that make sense are from -

@LemonRoses

@MissLucyEyelesbarrow

layperson

She won't do a visit because someone tested positive for covid

Luckily the care home staff don't refuse to go in! I don't know what's happened to GPs and why they are so reluctant to see people F2F. I'm sure they will have had their vaccines ages ago. Many other professions have just had to get on with it and haven't necessarily been vaccinated (care home staff, prison officers, police, recycling collection).

I would just get co-codamol from the pharmacy as you can get it over the counter.

This.
Being resuscitated is not like in the movies, it can cause serious injuries. For many people it would be being brought back to suffer on longer. But it certainly doesn't mean do not treat!

A lot of assumptions on the thread about poor intentions. If people considered good end of life care it would mean not dying in hospital after a long wait on a trolley in a corridor.

Aspirin and not visiting last week is entirely reasonable as a GP has no magic wand to reverse end of life. Nurses are the best people to assess the patient, make comfortable requesting pain relief from the GP. The pain relief should be organised sooner. Maybe the GP has not been made aware of urgency. I went and fetched a prescription for my mum from out of hours chemist. See if this is an option?

Absolutely. You don’t need an ambulance to get pain relief though

So at 22.15 at night , where is the best place to get pain relief for this lady ?

I think the nursing home is as fault. Of course you want to keep a 95 year old person out of hospital. But if she's I so much pain she can't go to bed. Then she needs to be seen in hospital.

What treatment are people thinking she might benefit from?

Pain relief , preferably sooner than in 12 hours time. I am fairly sure that sufficent pain relief is a vital element of proper holistic palliative care.

Absolutely. You don’t need an ambulance to get pain relief though.

You would hope. Quite often the lengthy waits on calls to surgeries/111 and call backs are leaving people in pain.
I had a paramedic out to administer eol meds not so long ago because all the twilight cnt were busy and this person was in pain and distressed and I'm not allowed to administer subcut injections. I was on hold to 111 for nearly an hour and then waited 2 hours for the paramedic to attend. I am absolutely not calling the people doing the actual job, the system has been run into the ground, it's appalling, and no one cares.
So frustrating.

The home is at fault here. They do not need a G.P. Authorisation to call for an ambulance.