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.

Sorry just saw your update! I was panicking on your behalf when I read that she wasn't. Ring taken to hospital.

Regarding DNR my understanding is it's very unlikely resuscitation would be successful and it is very traumatising both physically and for everyone involved. Speak to a sympathetic Dr about it as the first time it's discussed it's bloody scary but I didn't hesitate to have DNR put on my dads file.

Your poor MIL, can’t believe they hadn’t already called an ambulance considering she had to sleep in a chair because of the pain and can’t get to the bathroom. Glad you’ve insisted on one being called.

@Daisymae15

I hope all goes well 🌸

Please do not rely on the care home to do the right thing regarding phoning an ambulance. My husband had a call about my dad whilst he was in a home "just to let us know" that he had what they suspected at the time was pneumonia and they were going to make him comfortable but weren't going to treat him for it just pain relief. That sounds unbelievable now just writing those words. Of course we insisted an ambulance was called and met him at the hospital. He was very very sick with aspiration septicaemia and was given days to live. He actually managed to fight it off but died still, he had vascular dementia and his body shut down.

It doesn't sound unbelievable. Pneumonia is sometimes described as the old person's friend because it enables the patient to slip peacefully away in their sleep, giving a dignified end to a period of often considerable suffering. I'm sure your husband acted with the best of intentions, but was his father really better off in a hospital than simply being allowed to slip away peacefully in familiar surroundings?

Have not read the whole thread but we have a protocol that if a resident has a fall and is taking any anticoagulant and bangs their head we always call 111or 999 we do not bother with GP …having said that we will resist hospital admission at any cost because we care about the MH of the resident 💐

@MotherofPoodles

Please do not rely on the care home to do the right thing regarding phoning an ambulance. My husband had a call about my dad whilst he was in a home "just to let us know" that he had what they suspected at the time was pneumonia and they were going to make him comfortable but weren't going to treat him for it just pain relief. That sounds unbelievable now just writing those words. Of course we insisted an ambulance was called and met him at the hospital. He was very very sick with aspiration septicaemia and was given days to live. He actually managed to fight it off but died still, he had vascular dementia and his body shut down.

When dealing with care homes do not ever assume they will make the right decisions. Sadly underpaid inexperienced people are left with too much responsibility. I have many horror stories from my experiences . I really hope your mil can get well. Really scary to see such a dramatic change.

Did your Dad have a respect form ? Many residents do sign and explain their own wishes and normally their families are aware. It is normal practice for care homes to discuss everyone’s health and well-being on admission.

As others have said above, your anger is misplaced and should instead be directed at the nursing staff at the home. These people are presumably registered nurses and should therefore be capable of autonomous clinical assessment and decision-making. The GP will be making decisions based on the clinical handover of these nurses. Likewise, the decision to call an ambulance for a patient will be the responsibility of the nurses, not the GP. If they feel she needs admission given they are the only clinicians to have assessed face to face and they have neglected to arrange this, then they have failed in their duty of care regardless of what the GP says.

I too am appalled that your MiL has been left in considerable pain with inadequate pain relief. Again, this fault lies with the nursing home staff, not the GP - the GP has prescribed and is not able to magic the pharmacy open to collect the script. This should have been dealt with at the time of the fall and it sounds like an ambulance would have been appropriate at that time.

The TIA pathway for a resolved 'mini-stroke' usually is aspirin and referral to TIA clinic, so I don't think this is necessarily an issue from the information you've provided. Aspirin in itself is not a red flag for head injury as it is an anti-platelet not anti-coagulant drug - the nurses who assessed your MIL should be capable of recognising red flags in line with NICE guidelines and arrange admission accordingly. They will also have their own policy for monitoring after a head injury.

I would have an open and honest conversation with the nurse in charge at the home tonight and explain your concerns - if she is in so much pain she cannot mobilise, regardless of severity of injury then she may need admission tonight for pain management alone. Good luck and I really hope you manage to get your MiL the care she needs.

My husband had a call about my dad whilst he was in a home "just to let us know" that he had what they suspected at the time was pneumonia and they were going to make him comfortable but weren't going to treat him for it just pain relief. That sounds unbelievable now just writing those words. Of course we insisted an ambulance was called and met him at the hospital. He was very very sick with aspiration septicaemia and was given days to live. He actually managed to fight it off but died still, he had vascular dementia and his body shut down

And from another point of view, was the “right thing” an ambulance and likely a traumatising trip through a&e and hospital death? Death was likely inevitable, so why make a poorly old man “fight” it?

My grandma was the same. Dementia and pneumonia. We chose the other option, and she slipped away peacefully and painlessly, in her own bed a few days later. She had always said she did not want to die in hospital, and had we called an ambulance that’s exactly what would have happened, with “treatment” possibly prolonging her pain.

I'm a nurse in a hospital but 2 years ago worked in a nursing home. I had to call the GP a few times for residents - one as I suspected someone had a chest infection, they prescribed the eventually but by that time the resident had very bad backache so I got them sent to hospital where they were treated for pneumonia and sepsis. Another had a hypo (type 1 diabetic), again I sent them to hospital as there wasn't anything I could treat them with! I felt let down and scared tbh, that's why I left - my pin was put at risk by others actions. Escalate and complain is my advice.

Sorry I meant eventually prescribed antibiotics

Just a quick update a paramedic on a motorbike arrived at 1.45am. He has given her stronger painkillers and advised that she doesn't go to hospital as the
waiting time can be up to 6 hours. She is now asleep still in the chair as she cannot lie on her back.
DH will be phoning the manager in the morning.

@Daisymae15

Just a quick update a paramedic on a motorbike arrived at 1.45am. He has given her stronger painkillers and advised that she doesn't go to hospital as the waiting time can be up to 6 hours. She is now asleep still in the chair as she cannot lie on her back. DH will be phoning the manager in the morning.

I hope you feel ok OP.. Im glad she has been seen and assessed by a professional .. and you all get some rest tonight 🌸

Its the Tory Government.they want people to take out private health insurance.

@Megameg56

Its the Tory Government.they want people to take out private health insurance.

Clearly private care is the best option based on this thread!

Hope your MIL is treated. I'd start looking for another facility. This one doesn't sound competent.

Thank goodness she eventually got some pain relief, hopefully she managed to get some sleep and had a more comfortable night.

I am worried that she has been in the chair for such a long period of time, she will be at risk of developing pressure damge.

I don't think there is a cure for a fractured pelvis (perhaps some sort of pinning if it was a young person with a serious fracture eg from a car accident) - I would think it's bedrest until it heals which would be weeks or months. Perhaps an anticoagulant would be given for the tia but that would make bleeding from a fracture more serious.

But I would think that a drip could be set up with stronger painkillers if required.

I'm not sure it is anyone's fault that DM is in a bad way.

I don't think the staff at the home have advocated hard enough for your relative OP, she had a fall on Monday and the staff rang the GP and the GP still hadn't been in touch by Tuesday evening, the GP then prescribed medication that they knew wouldn't reach the home until late morning today at the earliest.
Did the GP suggest sending the prescription to a late opening chemist for collection and the staff declined ? Or was this option not mentioned ?
Did the staff chase the GP during the time from the fall on Monday until yesterday evening or were they happy to passively wait for a call back ?

@Vooga

I agree with others, it sounds like she needs more immediate care than a GP would give . I'm surprised at someone having a stroke and a bad fall and all that's been done is phone the GP surgery.

Could a GP not say, “you need to ring 111/999 and not me”. Is that too difficult?

I hope your MIL is seen soon and given appropriate care.

I'd be querying why the home didn't ring the paramedics after the TIA and certainly after the fall. Anything internally could have happened.

@Terhou

Please do not rely on the care home to do the right thing regarding phoning an ambulance. My husband had a call about my dad whilst he was in a home "just to let us know" that he had what they suspected at the time was pneumonia and they were going to make him comfortable but weren't going to treat him for it just pain relief. That sounds unbelievable now just writing those words. Of course we insisted an ambulance was called and met him at the hospital. He was very very sick with aspiration septicaemia and was given days to live. He actually managed to fight it off but died still, he had vascular dementia and his body shut down.

It doesn't sound unbelievable. Pneumonia is sometimes described as the old person's friend because it enables the patient to slip peacefully away in their sleep, giving a dignified end to a period of often considerable suffering. I'm sure your husband acted with the best of intentions, but was his father really better off in a hospital than simply being allowed to slip away peacefully in familiar surroundings?

I think the difficulty is in making decisions for a patient - where they cannot make those decisions themselves.

My mum was in a nursing home for terminal bowel cancer in 2019. There were no hospice spaces available and she had very complex needs (some mental health issues, although she was lucid, Crohn’s disease, copd, then the bowel cancer etc etc). She ended up being placed in a nursing home for mostly elderly people with high care needs under the NHS continuing healthcare scheme. I am / was her only child and only relative and I also have disabilities and a disabled son so whilst I visited every single day there was only so much involvement I could do.

Anyway, two days before she died I suspect her bowel ruptured and she was in horrendous pain. I complained as they didn’t seem to be calling anyone out to arrange a syringe drive for her or administering extra pain relief. She was still able to communicate at this point and I asked her whether she wanted me to ring an ambulance and get her to hospital so they could manage her pain better. Despite being in awful pain she said she didn’t want to go anywhere, she was tired and wanted to stay at the home. I fought tooth and nail that last day to get the home to get someone out to prescribe the driver - it took literally all day, from 8am till 10pm at night when they finally got it and put it in. She died at 11.30pm. I still have nightmares about it all now and wonder if I could have done more and feel terrible about it wondering if I should have got her to hospital anyway, but that was not her wish and as much as sometimes we want to keep our loved ones alive for as long as we can sometimes that isn’t in their best interests. However- no one should be in pain. That is just not acceptable. And prescribing Cocodamol (which you can buy over the counter in lower strengths!) in this case and not being able to get that sorted till the morning is just not good enough- surely the home should have some they could have given anyway?!

I think the actual nursing in many of these homes leaves a lot to be desired.

Calling for an ambulance doesn't mean that they will always take you to hospital- they have more diagnostic equipment and can give meds etc. than the home or GP has.

But still, I think you should be raising the issue with the home about not seeking appropriate treatment after a head injury. Contact the CQC.

[quote CrocodilesCry]@LemonRoses You mention painkillers and the OP's MIL being made comfortable without the need to be seen in hospital/by a GP - this is clearly not happening on either count. It's negligent.[/quote]
Indeed leaving someone with unresolved pain isn’t appropriate. However we actually don’t know the details and sometimes these things aren’t quite as seems. One needs to understand the situation properly before sitting in horrified judgement about the GP.

If the care decisions are such that there will be no transfer, then you wouldn’t call an ambulance. It would be entirely inappropriate. That’s often the right decision for people in nursing homes in most circumstances.

Hospitals aren’t about to perform a carotid endarterectomy on a frail 92 year old to stop funny turns. The correct pathway for anyone experiencing TIAs is not an ambulance- it’s aspirin and referral to clinic, if appropriate.

Pain can and should be managed just as well in a care home as in hospital, better in fact. They know and understand the usual behaviours, usual appearance and responses. Much easier to assess someone you know. If a paramedic can administer analgesia, so can a nurse in a care home.

The lessons to learn would perhaps be around having anticipatory medicines written up - I’m rather surprised they haven’t already got this, as that would be best practice for those approaching life’s end. That means last year or so of life, not their last days.

I rather suspect it’s about miscommunication rather than negligence or unkindness. The home will have been communicating with their resident who has capacity, not the relatives who are getting second hand messages via the resident. Sometimes there is a bit of misinformation when that happens.

@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.

Exactly - she needs pain relief and if other avenues have been exhausted I'd be calling for a paramedic.

@Daisymae15

Just a quick update a paramedic on a motorbike arrived at 1.45am. He has given her stronger painkillers and advised that she doesn't go to hospital as the waiting time can be up to 6 hours. She is now asleep still in the chair as she cannot lie on her back. DH will be phoning the manager in the morning.

Glad to hear the poor lady has finally been given some stronger pain relief. She will be much more comfortable now.

If they think she's had a TIA I would not be calling for a GP. I would be calling an ambulance to get that checked. I cannot believe they have waited for a GP callback. Utterly ridiculous