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????

He's not in pain, afaik the falls team (he has a wrist band to press when he falls, this has been a regular occurrence over the last year) assessed him and the physio at the time and decided he had not hurt himself. I wasn't there and was also not told (stoic mother again) about all this until a few days after so I don't know how these decisions were arrived at but with several people in attendance I am assuming their collective experience came into play?

He is not complaining of pain anywhere.

He is however definitely uncomfortable, not his former self, vacant and unhappy in the bed. This is why to me this is a GP or district nurse situation not a hospital one.

I appreciate fully if he goes into hospital we will not be allowed in. Our local hospital is horrible (mum was in there) and I know he'll be left alone in a room and that will be worse.

I understand the next step is a nursing home if some kind but in the interim he can't just lie awkwardly in bed until that happens.

@fuddleducks

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.

He has a wristband that he presses to get help from the falls team. They have been out at least twice a week since this was put in place in April. This has been part of the ongoing struggle with the obvious limitations that my mum cannot help to get him up.

Also just to add @fuddleducks both the physio and the carers have communicated their concerns to the GP.

If he is uncomfortable then he could be in pain, the physio and falls team cannot diagnose a fracture without xrays, some are very difficult to see unless its very obvious . He needs his urine and blood tested for infection and dehydration. The best place is hospital, if you dont get anywhere with the g.p can you call 111 for their advice.

Nurse here.

Please keep him at home, don’t call an ambulance unless you need to! Sadly once he’s been admitted he’s likely to deteriorate further and at higher risk of picking infections up. Most care agencies may only keep a care package for days once a patient is in hospital meaning he will need to be reassessed for social care (HUGE shortage right now) and could take weeks if not months! I know of patients that have been waiting 3 months and more.

Get a community nurse referral ASAP, they can assess your husband, dip and analyse urine and make referrals to occupational health for standing/moving aids amongst other things.

How often are carers coming in? Sounds like he needs a double up 4 times a day, have you spoken to the agency?

Your mother shouldn’t be struggling like she if she I’m very sorry they haven’t received the proper care and advice from the GP.

I see @jimmychoose. Your poor dad.

At the very least, he needs an assessment in ED. As another poster has just said, he needs bloods and a urine check plus XRays. He may need to be admitted while a package of social care is arranged (as we all know, this isn't easy for anyone to arrange).

He needs urgent assessment for pressure care if he is immobile and incontinent in bed . He is at very high risk of developing pressure sores.
I agree with what others have said he needs immediate medical assessment .

Does he have any wound Injuries from his falls?
I am a community nurse and would say that mobility needs would not be what we help with generally, that would be social care, nursing care could be things like bed sores (carers should be doing preventative measures, we get called if the skin integrity is compromised). We do catheters, dressings, injectable medications etc
I can understand the GP not referring to district nurses if his needs are not nursing in nature, because the referral would be rejected.
Physio and occupational therapy referrals are more appropriate for mobility and general help with daily living assessments, so certainly GP should refer for those.
Every area has different processes but where I work, as much as I am happy to help with these things and love to provide holistic care, there are policies and procedures in place which state who should be doing these things and as nurses sadly much of the social care side of things is no longer allocated to us as we have the more medical things allocated to us now.
Certainly sounds like he needs OT input though, they can also look at ensuring any things like pressure relief cushions are in place and who could well refer to nursing if he does in fact have some nursing needs.

He needs an OT & Adult social care input from what I have read? You are fine to speak with them yourselves, this doesn’t need to be a GP.

Has anyone explicitly asked for a home visit? General practice is utterly overwhelmed at the moment. Home visits are enormously resource intensive, so if there is any possibility of managing without most GPs will try to.
As far as onward referral for OT goes - physio and falls team should also be able to make these if needed, it doesn't have to be through the gp. You can refer to social care yourself. Not clear that there are specific nursing concerns to warrant community nursing referral, though assessment of pressure areas may be needed.

If I were you I would call the GP again, explain that he has deteriorated and are worried about reversible causes like infection and ask for someone to come out. I'd also advise having a frank discussion with your mum about whether you think he should go into hospital, and be prepared to discuss this with the GP too (note this is a discussion, not a concrete decision). Good luck!

Haven't read the full thread but I'd advise contacting adult Social Services. They have crisis teams that can co-ordinate care and equipment/referral to a rehab unit etc. GP will probably be pretty useless in this situation unless they can refer to a rapid response service.

@jimmychoose - this sounds really hard. Ring the surgery and ask for the Practice Manager.

Gosh if the falls team are coming out twice every week it sounds like more mobility assistance is needed/adaptations in the home.

How old is he?

This sounds properly shit, OP, but don't go nuclear at the doctor. Our surgery is taking a zero tolerance approach to verbal abuse from patients and family - and removing patients from their list.

If you think that you may lose your rag at the GP practice try an email first. Then you can review and edit so it is appropriately stern without risking flying off the handle.

Thanks everyone. He is already under the care of OT and carers etc, this is why this is a new development.

Regarding what district or community nurses roles are I appreciate they are not there to provide care or advise on mobility aids etc however as per my initial post he was supposed to be getting his covid booster from the district nurse, he was also supposed to be getting his b12 from them months ago, they have never come to do either of these. Now my MIL is saying it should be a district nurse who assesses him because he's bed bound and that has health implications... this is why I'm asking about this.

You should call ambulance

He can no longer weight-bearing after a fall. He msh have broken something along with having a UTI

A bed based patient should be turned 4 hourly throughout the day and on an armatures. Has this been provided.

As a district nurse I would arrange for an ambulance to go to hospital to xray him as he has fallen and can no longer weight bear and investigate why he is uncomfortable and vacant.. Why is mil reluctant to call an ambulance so he can be properly assessed and treated. Does fil have capacity to make decisions and agree to going to hospital.

OP I would go bonkers at them, disgusting behaviour towards you poor dad. But you have much more constructive responses here, I really hope you can get some help for him and your poor mum!

It's awful he's been left like this for 10 days and the poor carers must be struggling to manage his personal care needs on the bed without the right equipment. Ask OT what the time scale is for the moving and handling equipment - in our area it can be put in place in emergency situations within 4 hours. He's likely to need a hospital bed and mattress for pressure care.
He needs a health assessment, is this reversible such as a urine infection.
Surely your dally team/physiotherapist should be able to make the appropriate referrals.
Priorities are around getting his medical state assessed. Moving and handling equipment/care on the bed equipment in place and the right level of care package to reflect his current needs. I'd be cautious about starting him on sleeping pills as the can increase risk of falls and disorientation which might make nights harder for your mum.
Hope you get sorted x

My concern would be he broke or badly sprained both or either arm or hip or leg.

So

Can you explain what the fall team is?

What medical knowledge have the fall team?

What do they do?
How do they decide if he should be lifted off the floor?
How do they decide if he needs to go to hospital or not?

So after a fall he was discovered to be no longer weight bearing? I'm a bit gobsmacked he wasn't taken into A&E for assessment that day.

I’m a nurse .
Your father should have had an ambulance called immediately when he was unable to weight bear after a fall .
He needs to be assessed for fractures/injuries as well as the reason for his fall ( eg: did he have a stroke , dizziness , infection etc ).
I don’t understand what you are expecting the GP or district nurse to do . Though don’t understand why they didn’t recommend A/E.

OP, regarding your recent post, your MIL does not seem to have a correct understanding of DN roles.

Good luck.

Roundeartheratchriatmas

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.“

Agree with this. 24 Hours in A&E just last night, a 90 something lady broke both femurs simply falling from chair height.