to complain to GP surgery? If not, what has gone wrong here?

[A580Hojas]

My mother was discharged from hospital to a care home 3.5 weeks ago. She was in care for 3 weeks repsite care, and has now gone home.

Her discharge letter prescribed 9 different medications, with the words "GP to follow up" on all the prescriptions on the letter.

But the GP did not follow up. Nor did the care home who had a copy of the letter.

All this came to light after she had been in the care home for 9 days.

My brother got hold of the pharmacist at the GP surgery and asked why my Mum had been left for 9 days without prescribed medications. He said "I don't know" but did arrange for them to be dispensed and dispatched to her within a couple of hours.

Does this sound bad to you? What is the usual procedure in these circumstances, does anyone know before I start a complaint?

The hospital usually discharges the patient with 1 or 2 weeks worth of the new meds, otherwise even if the letter was acted upon promptly, there would still be a risk of a gap in treatment. I have never known a hospital to start 9 meds then just discharge the patient without them 🤔
I would contact the hospital to ask what she was discharged with, then go from there.

The fault is with the person passing the blame to the GP instead of prescribing the patient enough meds

Agree with the above replies. This is a regular problem with hospitals not discharging with necessary meds even though that is their responsibility. They then pass the buck to the GPs in order to save on hospital funding. Our GP has raised this with the local CCG numerous times but the hospital always denies they do it so no action is taken.

Agreed, the fault here lies more with the hospital and a little with the care home. The hospital for not discharging with a supply of medication and the care home for not noticing the lack of medication.
GPs wouldn't normally pick up discharge letters for a while after discharge, sometimes longer than a fortnight depending on how the hospital sends them.

@DeckTheHallsWithGin

The fault is with the person passing the blame to the GP instead of prescribing the patient enough meds

Who is this? Who is passing the blame to the GP?

As above, the patient should normally leave hospital with at least 7 days of medication, if not 2 weeks.

When the surgery receives a discharge summary the patient's medication list will be updated with the new medications so that they are ready to be issued but in most surgeries nothing will actually be issued until a request comes in (from the patient or the home etc).

So she didn't go to the care home with any discharge meds at all?

The fault likely lies with the hospital. They should have discharged with at least 7 days meds to allow for the discharge letter to be forwarded to the surgery and hopefully the pharmacy if she uses a regular one to get the meds sorted.
The GP surgery won’t know that she needs them and when unless the hospital have told them.
I’m my experience of working in local health care and pharmacy until last month the hospital are not always good at doing their bit.

So if she was discharged from hospital to a care home, she should have gone with a supply of medication, normally 2 weeks but some care homes ask for 28 days.

If the care home realized she didn’t have meds that should have been actioned immediately.

When discharged home from hospital, meds should also be provided and the discharge notification would go to the GP but the onus is on the patient or a representative to request more meds. We always remind people to do so in good time.

I work for a MH Trust so we might do things slightly differently but that’s essentially my experience of acute Trusts as well.

As part of discharge planning the patient should be provided with a 7 day supply of medication - this is to tide them over until the GP has received the discharge letter and actioned it. If this didn't happen - you need to bring it up with the Hospital.

The care home have a responsibility to ensure that their residents are taking their prescribed medication - there so many protocols around this it's amazing they have overlooked the missing medication as well.

So the GP's are pretty far down the list of folk responsible or to blame.

Yes standard for hospitals around here to issue two weeks of meds on discharge. Gives enough time for GP's to issue and the pharmacy to recieve the prescription, order the stock and dispense. Given 'standard processing' times for prescription requests at GP surgeries is 5 working days.

Someone has to actually request the medication from the GP also, however I would have expected the care home to have noticed the paitent didn't have any medication. But if they hadn't seen the discharge then they also wouldn't know. I'd probably say fault was with the hospital.

Actually I want to add, care home manager is also responsible as they knew that they should be on meds but did nothing about it.

The person responsible at the hospital will be whoever discharged them, presumably the duty doctor. However as I said before this is a common nationwide problem and the hospital are unlikely to admit responsibility and will possibly even deny it happened at all. I have seen this happen time and time again.

As long as it's sorted that's the important thing. Why make other peoples already difficult lives even more difficult.

Dh was in and out of hospital for the last year of his life. He always came home with 2 weeks' meds and I always had to chase the GP for the next lot. TBH getting hold of the pain relief he needed was one of the most stressful parts of the whole thing

When mil was in a care home (18m deceased) the hospital sent her home with 2 days worth of meds and a letter. It was up to the care home to contact the pharmacy and GP for follow up and meds. Took several calls to three different pharmacies before locating the required meds.

Definitely a hospital fault and the discharge team. When I’ve left a hospital and need a follow up I’ve been given 10-14 days worth of medications and a discharge summary as well as a letter going to my Gp. It takes ages for the letter to get to mine so i contact them myself normally.

By “passing the blame” I mean passing their responsibility for discharging the patient with sufficient meds to the GP to deal with when actually it’s their responsibility. Having said that when my son was diagnosed with a serious illness needing multiple meds I went to the GP surgery in person the day he was discharged and handed them the list of meds that needed to be added to his prescription myself to minimise the delay in getting them all added. He had a least 2 weeks worth on discharge.

List being a copy of the discharge letter from the hospital.

In our area the bed base rehab units require 28 days medication supplied from the hospital which we supply. Other nursing/care homes etc, we check with them how much they would like us to supply.

Most of these places have a duty doctor who will continue to prescribe their medicines and a pharmacy contracted to supply them. I would be wondering why this wasn’t picked up by the respite centre. Once they have the discharge summary they should flag to the hospital if they are missing any medication or a MAR chart.

Hospital pharmacy discharges patient with medication, typically two weeks worth.

GP receives the discharge letter and adds new medication to the repeat medication list.

Patient (or staff if in care home) request more medication via GP

@Nelliephant1

As long as it's sorted that's the important thing. Why make other peoples already difficult lives even more difficult.

We (as a family) are not quick to complain. Something went wrong in this process so the fact that it was sorted after 9 days is OK but not ideal. You don't think we should just be quiet and be grateful? or do you?

I asked the question as, as a lay person, I have no idea of the usual procedures.

GP to follow up means asking the GP to check that the medications are being tolerated/working etc and then to make a decision regarding continuing them. Not for the GP to start the prescription (unless there’s an additional instruction e.g. please check x blood test on day y and depending on results prescribe z).

The hospital should have discharged her with the meds on discharge (varies from trust to trust but for repeat meds somewhere between 7-14 days is usually prescribed). For a nursing home a medication record chart +/- nomad box would often be made up on discharge for ease of administration. It’s then up to the patient to get in touch re a repeat prescription. The GP will be copied into the hospital letters but they get literally hundreds of them a week (depending on the size of the practice) so it can take a while to process them.

As your mother is in a care home (and I’m presuming not capable of contacting/requesting a medication review herself) I would expect the care home to be responsible for contacting their GP regarding the medication review to ensure this happens on time. It’s incredibly strange to be discharged without medication, especially if admitted for more than 48 hours. I think your anger is best directed at the care home or the hospital rather than the GP who by day 9 probably hasn’t even had chance to read the letter yet!

It's quite difficult for my 90 year old mother with complex medical needs wasn't given the medication she was prescribed. I'd say that is "difficult".

Thanks everyone for your replies.

@RonWeasleysBackfiringWand

The hospital usually discharges the patient with 1 or 2 weeks worth of the new meds, otherwise even if the letter was acted upon promptly, there would still be a risk of a gap in treatment. I have never known a hospital to start 9 meds then just discharge the patient without them 🤔 I would contact the hospital to ask what she was discharged with, then go from there.

Thank you. She was already on various medications before going in to hospital, on regular repeat prescriptions. The hospital added some additional ones. I think I need to ask the care home what she came to them with.