To expect a health professional ie the GP to actually see my dad in the flesh??

[jimmychoose]

I am just, only just, holding back from phoning my parents health centre and going absolutely tonto at them so I think i need a rant first to get some perspective as maybe I AM being unreasonable here. Will try to keep brief,.

My dad has several chronic illnesses and has had mobility problems for years but got around between a wheelchair and his own very slow shuffle on his feet for years.

Since Feb this has quickly declined and we had to get carers in as he was less able to get around the house. My mum although generally healthy had her arm amputated three years ago and is still adapting/recovering from this herself.

About 10 days ago my dad fell out of his wheelchair while my mum was out shopping and was on the floor in the kitchen (it’s an old farm house quite cold stone floor) for at least an hour.

My mum got help from the falls team and it just so happened the physio who has been helping once a week turned up at the same time. They discovered my dad was now unable to bear any weight at all on his legs and so cannot be moved from wheelchair to stairlift or wheelchair to bed for example. He said my dad was to be put in bed and kept there until he was able to get hold of a hoist system. My dad has been in bed since, lying very awkwardly unable to move or turn himself. He’s also doubly incontinent and has been for a long time.

My mum tried to phone GP for two days and could not get through, contstantly engaged. Physio thought maybe a UTI as dad also very weak and disorientated. About 3 weeks ago conversation with GP was a district niurse would come out to give my dad his Covid booster + flu. This has never happened.

So physio has been brilliant phoning to check mum said can’t get through to GP, so physio contacted GP himself and lo and behold GP phones mum yesterday.

Cue a conversation of “oh dear, that’s a shame, uh huh, i see, yes… well that;s just old age I’m afraid, no there’s nothing we can do about it… that’s just the march of time…” all this type of bollocks?????

My mum then said although he can’t move himself he’s having trouble sleeping and in the morning she finds him halfway out the bed with the covers all over the place - what about sleeping pills? GP response - oph yes no problem you can have sleeping pills i’’l get that sorted for you.,..

Is that not utterly mental?? This is a random GP who has never met my dad or my mum, is just taking my mum’s word for all this, has not seen my dad in the flesh to confirm his condirtion or state of mind, but is handing out sleeping pills to a third party to give to my dad?

However my in laws are NHS people mostly retired and all appalled are saying because he is bed bound he should be instantly prioritised for a district nurse assessment? Is this correct? I am so angry this GP has basically dismissed my mum, not been remotely concerned to even ask to speak to my dad never mind arrange to see him or send someone else out to see him, and lastly to just prescribe sleeping pills like candy???

This is not the first time we’ve spoken to the GPs at this practice to try and get help for my dad this year, it’s been different GPs but the same response every time. Also takes 2 weeks to get a phone appointment.

He’s been a patient at the practice for 40 years.

The person who has helped most is the physio who arranged a incontience nurse to see him and a dietician too - he’s 8 stone and lying bent up in bed like a stone statue and apparently there’s nothing that can be done????

God that sounds so hard. How is your mum expected to cope with this with only one arm? I have no answers but just wanted to say I agree with you and this isn't right at all.

You might want to ask MNHQ to move this to the Elderly Parents board, lots of help, support and practical suggestions on there from those of us who have navigated through this.

Yes that is crap
Do phone up and complain
Polite but firm. Ask for he complaints procedure if you get no joy

1. He is newly off his legs and possibly newly confused. It is not a chronic situation it may be reversible. Common signs of a UTI in older people include new onset of confusion, incontinence, falls and loss of mobility

1. Even if it is chronic he is not able to be properly cared for now. He is essentially being neglected (use that word) and not having his needs met. He urgently needs a care package. NHS reablement is available for these situations to prevent admission

If all else fails tell them you will be calling and ambulance. I honestly do not think you would be unreasonable to do so.

Lord above, that sounds very unsatisfactory. He could have a broken hip, fgs.

It is often the Allied Health Professionals like Physio’s that do the most, but even their hands are tied if someone medical is not willing to do a proper assessment of the situation

To me, it sounds like he needs admitting to some sort of assessment unit (local to me it is called AMU, acute medical unit). Here he would get assessed by doctors, adult social care, physio and occupational therapy. His needs have obviously changed greatly.

The physio actually said to my mum if he gets worse call an am,balance, she’s the kind of person who wouldn’t - ironically- until the actual dying throes!! But that just shows you where things are right now, he obviously knows that’s the only route to get action.

What I want to know before I phone is, is it the GP who should be coordinating this?

Thats just awful. Even if there's nothing doctors can do to 'fix' the mobility problems (sadly, they are likely correct about age), the absolute LEAST they could do is get social care involved and start the ball rolling on getting nurses in to help multiple times daily. It also sounds like he may need a nursing home, but they're happy to let him rot.

I don't know if home visits are still happening. Our GPs are seeing people face to face but not doing home visits so I don't know if that's everywhere, but if he gets worse and she needs support I really would consider calling an ambulance. Ward staff can then do what the GP should.

But surely a district nurse is the person to do home visits then - but the GP should be organising this? We have carers in already who were showering/changing him etc but now that he’s bedbound it has changed the situation as they are saying there needs to be two of them to do each visit, but it’s also about his comfort etc, my MIL says he needs to be assessed for bed sores, for choking hazards when eating etc long list of potential issues with someone immobile in bed??

Sounds like he probably should have been assessed in hospital on day 1. There is not much I expect a GP doing a home visit would achieve unless your dad has previously expressed that he wouldn’t want hospital based treatment.

I’m a gp. Sorry unless I’ve misunderstood, your dad had a fall and since then can’t weight bear? Sorry but the physio should never have put him back in bed- he needed to go to hospital right at the start to check for fractures! Unless you mean he couldn’t transfer before the fall?

The district nurses were brilliant when my dad needed help, but it is the GP that needs to be making an urgent referral. I'd be very concerned about his risk of pressure sores, on top of all the other issues. The nurses can arrange a hospital bed and a special mattress if needed, as well as a hoist.

If you're able to get into the surgery, I'd go and sit there until somebody helps you.

GP is responsible, but it does get slightly more complicated as housing adaptations - like a proper/full hoist system (so one that’s built into the ceiling) - are a social care thing. Has your father’s social worker been any help?

Appalling that your father was left in that state without face to face assessment: there is no excuse for callously writing off deterioration in the health of elderly people, and complaining to the Practice Manager about this approach seems perfectly reasonable.

Does he have any hospital consultants whose input could reasonably be sought?

I really REALLY hope you can get this sorted soon OP - it must be horrendously stressful for you

Please take care about hospital admissions. Once he is in, he won't be allowed visitors, and the staff are so stretched that essential care goes out the window. I say this from very recent personal experience, hospital should be a last resort. Everyone I saw left in a worse state than they arrived. That's why the physio is trying to help him stay at home.

If the GP won't do anything then it sounds like the only option here is to call an ambulance to get him admitted - but what a waste of resources when it could be handled differently. At least if he goes to hospital you can refuse to have him discharged without a Occupational therapist and Social care assessment for care and equipment.
If a UTI is suspected has anyone even done a urine sample?
It sounds like your dad needs an airflow mattress and hospital style bed to prevent pressure sores. Slide sheets will help with repositioning. District nurse could arrange these. A hoist is needed to get him out of bed if he can't weight bare and is able to sit in a wheelchair. I hope the carers are using plenty of good quality barrier cream to help prevent sores (Cavillon cream is the best IMO).
Yes he may be old and for some, sadly, this is how it goes, but the GP still has a responsibility to make sure your DH is comfortable and not worsten the issues by neglect. Are all the GPs in the practice as patronising or can you speak to a different GP or the Practice manager.

My MIL has macular degeneration and was having injections in her eyes which were preventing the condition getting worse. During lockdown it all stopped and during an on line consultation with a different doctor she was told she was being discharged as at 93 of course her eye sight was getting worse, 'there there dear what do you expect'. MIL was fuming . She may be 93 but lives independently, absolutely has all her marbles and mobility and a memory I am jealous of at 57! She didn't take it lying down and tracked down her original consultant, who having met her was furious at his colleagues decision. She is now very much back on the list and having treatment again - which is working.

I wish you luck - those who shout loudest and fight will eventually get somewhere!

Unless I’ve misunderstood an ambulance should have been called at the time of his fall if that then meant he could no longer get up. Then he could have been taken to hospital for assessment.

There’s not much a GP could do if say he’s broken something. He needs to be taken to hospital really from the sound of it.

I think it sounds like he needs a trip to A&E to x-ray his hips and generally check him out after lying on the floor for a long time.

If he can't put weight on one leg, he may have broken his hip?!

To add- the GP would not have been able to do much apart from advise that he needs to go to A&E, based on the story of what happened.

Even if they did a home visit, that won't add anything- sounds like he needs his hips x-rayed and generally checked over- the GP cannot rule out a hip fracture just by looking/touching

Fair enough, complain to the surgery if you want to, but I think the priority right now would be to get him to hospital

As far as I can judge from what you have written, he should have been admitted to hospital after the fall as he was suddenly unable to weight bear and had clearly deteriorated.
It isn't clear how your mum managed to get urgent help from the falls team, nor how they got him off the floor (hopefully this was done with the correct equipment). Either way, with such a significant change in his mobility, he should have had Xrays, etc. There isn't much that a GP would be able to add in these circumstances by coming to visit and your dad was assessed by several HCP from what you have written. Even assuming the physio, etc were right in putting him into bed, they could have contacted the GP/ urgent care teams, etc themselves and communicated their concerns.

I agree with others, I think he would be better going to hospital to check he has not fractured his hip or pelvis after he fell..

HNRTT in detail but if it were a family member, I would want a confirmation that the deterioration relates to 'wear and tear' rather than a UTI or another cause - There are many different, treatable reasons even if age-related deterioration is the ultimate diagnosis. You need to have bloods done and a face to face visit. Insist on bloods froma plheb home visit then a GP visit. If your practice won't then I would call 'out of hours' with a 'deterioration'. If you get no progress then there are costs and benefits from triggering an ambulance and A and E assessment from a 'deterioration', especially if COVID boosters have not been administered but without an assessment, the current position might become permanent.

Good luck.

Also wanted to say- YANBU to want him to be seen by a medical professional

But it's not really the GP he needs right now- it needs to be an A&E doctor

So sorry OP you must be so worried. The GP should have been more help with telling your mum what to do & making referrals but it sounds as if as far as treatment & support goes your dad needs an X Ray to check for fractures & to be reassessed by social services for an upgraded care package.

Sounds utterly appalling and difficult for you all. He needs a district nurse assessment, occupational therapist and social care assessment. You can ring the GP surgery and tell the receptionist that's what you need. Sometimes you really need to kick up a fuss about this to make sure it happens. It can help if you get the hospital to tell the GP surgery to do it - but the hospital would need to see him first, obviously, which may be tricky.

And the GP has already promised a district nurse visit which hasn't materialised. Chase this! Phone the GP surgery reception and ask when it's happening. It may well be that he needs regular district nurse visits from now on for things like continence care and pressure sores.

There is nothing a GP can do if a possible fracture.
He never should have gone into bed without hospital ax and X-rays. I strongly judge that action, as another hcp.

Some of the advice on here has no clue of the roles/limitations of each hcp.

It does vary by your dads condition, background, wishes for care, active treatment etc. but I would say he needs his hips xrayed, bloods taken and a urine dip for starters. Hospital is the appropriate place if he wishes to go.

And, as PP said, he really needs to be seen in hospital for possible fractures, even if that's hard to arrange.

It sounds like your father really needs to be moved up to the next level of care now. Being bed bound and doubly incontinent ... and your mother with only 1 arm! Is being at home really appropriate for him? It sounds like he's really suffering. In your position I would be having the difficult conversation about moving into a nusing home.