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.

So glad your MiL has got her pain relief. I hope she is well this morning. Everything @FreyaHazel says rings true - ultimately this sounds a failure to get adequate painkillers in a timely manner which ended up with her being left with unmanaged pain and a 3am paramedic visit.
I would be having words with the nursing home about how to avoid this again - could they have asked the GP earlier for pain relief, could they have flagged it as urgent so it got to the pharmacy in time, or should they have a protocol that out of hours urgent meds go electronically to a 24 hour pharmacy if you have one locally?
I’m a GP trainee and it can be difficult but we would always bend over backwards to avoid someone being in pain over night or over the weekend - I will often do a green paper script and arrange a carer or relative to pick it up so if the usually pharmacy is closed or out of stock they can try elsewhere, especially on a Friday or late in the day.

DNR is not to justify neglect

@Megameg56

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

Unfortunately there aren't any private A and E departments

How is she today OP?

DH spoke to the nurse this morning & before lunch Mil had slept a little last night still in pain. The stronger painkillers from the GP only came at 11.30am.
She is still very depressed and not got out of the chair unless to go on the comode. She won't like that. Still not allowed to visit.
DH has just spoken to the manager and he might as well have talked to a brick wall. She couldn't understand why he was upset that his mother is in pain.
(At the end of the call she told him that she was leaving on Friday & the home is being taken over in December) She insisted that it was up to a doctor if an ambulance was called.
DH is reporting this to the cqc. What a shambles.

Wow just wow. Your poor mil, why cant you visit, I am glad you are reporting this to the cqc, it sounds like they dont care and what happens after the manager leaves, are they employing another manager, will residents need to move. If you are concerned I would also speak to adult safeguarding at social services, if the manager is a registered nurse you can also speak to their governing body, the NMC. I am really disappointed to hear that they dont seem concerned about her pain and insist that they cannot call an ambulance. Is it a small privately run home or part of a chain. Is she private or could counci funded. I would be wanting to know why she wasnt seen, how did they diagnose a Tia without a doctor seeing her, how she fell, what injuries she sustained, why the doctor didnt come out if a paramedic can then so can a doctor. How do they know she hasn't fractured anything, what do they plan to do if she deteriorates and still hasn't seen a doctor. I would also be asking what lifting and handling, mobility, pain relief, falls prevention and all other care needs have changed since the Tia and her fall.

Mil is funding herself £4052 per 4 weeks.
The company taking over in December has a lot of good reviews so hopefully they get a better manager.
We can't visit this week as someone tested positive for covid and they went into lockdown.
Over the last few months a lot of staff have left don't know why.
The nurse DH spoke to this morning was very informative about Mil which they are not normally.
Unfortunately the other homes in town are full or not suitable for Mil. Will be phoning again after 7pm.

The staff may of left because it's a crap home with a shit manager. It sounds like the nurse was helpful, was it the night duty nurse. I hope you get some answers and mil recovers quickly , has she been swabbed for covid. . Sometimes it helps to write down questions you want to ask I always think of something afterwards. Has your DP managed to actually speak to the doctor at all.

Can you ask them if she has a pressure relieving cushion ? I am really concerned about her spending so long in the chair, it would be awful if she developed pressure damage on top of everything else.

High staff turnover = poorly run home.

frumpety makes a very good point, you can ask what kind of chair is it, a tilt or just an ordinary armchair with her legs dangling which is not good for long periods. How are they getting her from the chair to a commode, has she had a mobility assessment, how are they managing her pressure areas and her bowels, co codomol can be very constipating especially if you're not moving about.

£4000 a month for this service?

Surely anyone can call an ambulance. I did late one night because my husband had severe abdominal pain. My aunt was in a care home and they phoned me to say she'd had a fall and was in hospital. No messing about. Care homes sounds negligent to me.

Hospitals aren’t about to perform a carotid endarterectomy on a frail 92 year old to stop funny turns

Please don't patronise people @LemonRoses

Nobody is expecting those sorts of procedures on the elderly. But this is someone's mother, someone's loved one we're talking about who was in pain and didn't get appropriate care for the best part of a week.

My DGM aged 90 is in a home, she has Parkinson's and falls regularly. She was in hospital on Christmas Day due to a fall and a bump on the head.

The home did the right thing for her despite it being Christmas and her missing her Christmas dinner and despite the Covid risk. Because she needed to be checked over. It was the right thing to do.

Seems some GPs and homes really do think DNR is the equivalent of do not treat - it's not right.

CrocodilesCry Not patronising anyone, being very serious.

If nobody expects these sorts of procedures on the frail elderly, and aspirin (which she had) was the prior step for TIA, what would an ambulance transfer for a TIA achieve? It achieves higher risk, discomfort fear and blocks in emergency departments.

How was her bump on the head checked exactly? I can’t imagine she had a CT? You mean her observations were taken and didn’t indicate raised inter cranial pressure? What stopped nurses doing that in the care home? A bit unkind to transfer her for a minor bump.

What does her ReSPECT form say about transfer and limits of care? That is the key to good, compassionate care as oppose traumatic transfers to appease relatives.

I dont think carotid endarterectomy procedures help if you have suffered a cerebral bleed but without a scan no one will know what caused a Tia. My elderly mother had one done, I have seen carehome residents have fractured hips repaired.

@LemonRoses

CrocodilesCry Not patronising anyone, being very serious.

If nobody expects these sorts of procedures on the frail elderly, and aspirin (which she had) was the prior step for TIA, what would an ambulance transfer for a TIA achieve? It achieves higher risk, discomfort fear and blocks in emergency departments.

How was her bump on the head checked exactly? I can’t imagine she had a CT? You mean her observations were taken and didn’t indicate raised inter cranial pressure? What stopped nurses doing that in the care home? A bit unkind to transfer her for a minor bump.

What does her ReSPECT form say about transfer and limits of care? That is the key to good, compassionate care as oppose traumatic transfers to appease relatives.

She needs to be assessed to establish the severity and location of the stroke, her meds need reviewing - anticoagulants may be appropriate, and she needs to be assessed for fractures after her fall.

@LemonRoses

CrocodilesCry Not patronising anyone, being very serious.

If nobody expects these sorts of procedures on the frail elderly, and aspirin (which she had) was the prior step for TIA, what would an ambulance transfer for a TIA achieve? It achieves higher risk, discomfort fear and blocks in emergency departments.

How was her bump on the head checked exactly? I can’t imagine she had a CT? You mean her observations were taken and didn’t indicate raised inter cranial pressure? What stopped nurses doing that in the care home? A bit unkind to transfer her for a minor bump.

What does her ReSPECT form say about transfer and limits of care? That is the key to good, compassionate care as oppose traumatic transfers to appease relatives.

It's taken the family to intervene to get painkillers sorted out after her fall, so I doubt very much the home is following any such ReSPECT form. She's been neglected and left in pain, unable to get into bed. That is not good care.

OP I hope you hear some better news once you've spoken to the home again. It's so very hard especially as you're not allowed to visit.

TatianaBis She really doesn’t. That idea is well outside of pathway for TIA. You denied to go to hospital to have a meds review. Neither should initial assessment for fracture be outside scope of home staff.

Given the person has capacity and the OP hasn’t visited, it’s a very one sided opinion rather than an accurate reflection necessarily. The home may have a very different perspective.

Goodness, the home said she has not been able to move, in pain , and sleeping on a chair- it’s hardly one sided opinion.
And whether she has mental capacity or not, is irrelevant when you are vulnerable and in pain, you need someone right your corner.
Sadly some of people in these professions become numb to it all. Oh it is another day and another old person falling, dying, etc.

Are you by any chance a carer there?
This is someone’s mum and in pain.

*Fight your corner not right

LemonRoses, how do the staff assess for fractures of the spine, shoulder, pubic rami and pelvis. Have you worked in a carehome yourself as a hcp.

As an A&E nurse I'd say she absolutely does need checking over in A&E - I can see why you're frustrated OP. No one has X-ray vision, she's had a fall and is in a lot of pain. Older people have weaker bones she could have a broken bone that needs treatment and that would also help with her pain.

@Daisymae15, out of interest, which Care Home company is this, if it's being taken over in December?