To expect my elderly dad's surgery to offer non-digital options?

[CaringForMyElderlyDad]

I care for my 89-year old dad. Alongside many other responsibilities, I help him to manage his medication by putting his tablets into dosset boxes.

When he is running out of something, I ask him to call the surgery to request his repeat prescriptions. I write down what he needs and when he needs it by, along with the number for the surgery. Then I check that he has made the call.

I probably could order it from the surgery directly, but until now, it has been something that my dad has been able to do for himself. And as that list of things is gradually diminishing, I feel that it is important for him to be able to do it.

However, he rang today to request some tablets that were running out, and they instructed him that the only way he can now order a repeat prescription is online. Which of course he couldn't do, because he is 89 and struggling with the consequences of cognitive decline.

Obviously, I can do it for him so it isn't an issue, but what if I couldn't? Surely it isn't reasonable to expect all elderly people to be able to access digital options?

To be honest, I don't really understand why he needs to order the repeat prescriptions at all. The GP surgery knows what he takes and how often he takes it, and it should be easy enough to figure out when he will be needing another batch. But I accept that he does have to order it, and that's fair enough. I cannot accept, though, that he should have to navigate his way around an unfamiliar online system simply in order to get what he needs?

Not all pharmacies do dossett boxes. I set the service up for my mother. She received 2 and then they stopped doing it. That was Boots.

Our surgery has a ‘Prescription Line’ every weekday 9-4pm for those who can’t order via the NHS app. I think your surgery is falling foul of Disability legislation and laws protecting against discrimination by age. I would write to the Practice Manager explaining how difficult the online ordering of repeat prescriptions is for your father and that the practice is failing to meet his health needs. Advise that it compromises his dignity, confidentiality and independence to be forced to rely on you.

That’s extremely harsh.
The inclination, but more importantly the wherewithal (psychological, financial, technological etc) to ‘keep up with modern life’ diminishes as you age unless you happen to be well furnished with a multi-generational family and social circle, in my experience.
Living alone ‘abroad’, age 70, and of a reclusive nature (well, in fact pathologically hermit-like), I am trailing way behind with things like What’s App (which a few of my favourite online suppliers have adopted, so I’m out!) but worse is short-lived tech software, just as an example of increasingly precarious relationship with essential modernity.

My iPhone is so old Apple no longer support any aspect of it, so it’s a dumb phone now. (God help me if my bank decides the authorisation codes they text one to facilitate a purchase shall henceforth be messages on Twitter, or a What’s App thing!)
PLUS! Arthritic fingers! I can’t believe how I used to type like the wind on that phone, years ago. Now it’s all I can do to press the correct button for a text msg. Oh woe.
Seriously, physical disintegration does have an impact on the technological interaction demanded of us,

Last year I was ‘locked out’ on my iPad from a number of retailers on whom I rely very much, on account of my software becoming outdated and thus incompatible with theirs.
When my weekly grocery deliveries were made impossible due to this, I felt like the sky had fallen. Blind terror, in fact.
(There were logistical problems preventing my installing any upgrade, so it all had to wait months til I ordered a new bloody iPad.)
During all that time, I was thinking about my late mother, and how she would have metaphorically turned her face to the wall and given up entirely.
People DO admit defeat, unfortunately. It’s a lurking temptation, I assure you.

My point is, personality is a factor and not everyone will be equipped, one way or another, to stay on top of things, techwise.

If a person feels disenfranchised from modern society, finding just too many barriers to participating enough to remain clued in, they may possibly chuck in the towel, and retreat from it altogether. It’s very sad, and extremely unhealthy.
That’s a poor outcome merely for an inability to cram an ageing bonce with all the latest know how, and to acquire expensive devices, of course.

Feck SM apps though, and any business which demands one’s adoption of such (independents whose ‘website’ is instead an Instagram account, as a weedy example!)

Precisely! It’s all very well striving to damn well keep up, as has been so kindly advised, but at the same time as that effort’s being made, aptitude for it is diminishing alarmingly fast, for many.
Physical and cognitive decline is real, and it’s cruel how these curses affect disproportionately those elders who have very few people on whom to rely for support.

The cognitive decline part of your post bears thinking about. The user experience and design of NHS and government websites is particularly poor and not intuitive.

But on the age issue I am becoming less and less convinced by this argument. Computers have been in family homes for 35 years now. They have been part and parcel of life since most of the “elderly” of today have been in their 50s

As a pp has already said, you have no idea. So many unpleasant posters on MN at the moment, real know-it-alls who simply can't see past their own noses.

Oh do bore off. My elderly DPs had no experience of computers, had never had to use one in their work or their home life. They would be in their 90s were they still alive and were already finding the digital world difficult in the last years of their life. Most of my friends' parents were in the same situation. My 82 year old neighbour has never had a computer, nor does she want one.

Not everyone spends all their lives online you know, some people actually get out there and do things. You obviously have little to do with such people and live in your own little bubble.

But in their 90s would put them near a decade older than this man? My point is when my grandparents were in their 70s this excuse was common place, but there’s a rolling age where actually these people did have the exposure and chance to become familiar with computers. There’s a difference between getting out there and refusing to learn to engage with the way the world is moving.

You aren’t saying your neighbour can’t learn to use a computer or indeed smartphone, you say she doesn’t WANT to. Well I don’t want to have to contact my energy company/bank/job interview/dentist/doctor online; but that is the way the world has moved. You can’t claim an accessibility issue when the issue is just you refuse to try

My dad died recently in his mid 90s....

From about 90 he could no longer see enough to use a computer and his dexterity wasn't sufficient. He had a technical job in professional engineering where he learnt computer systems when he was in his mid 50s about 40 years ago..

Not all older folk have no experience.... But take your point equally that often older folk just weren't exposed to them,

If you have a second device that allows the NHS app, you can sign in as him on that device and manage his affairs that way

I would speak to the practice manager. Like others have suggested I would get a separate phone, download the nhs app for your dad and deal with requests through there. It's an utter shame that rolling out a process they think is more efficient is actually taking autonomy away from your dad.

A practice I have the unfortunate experience of dealing with recently said that patients could no longer phone for repeat prescriptions, instead they expected patients to tick off the items they need on the physical repeat and put in in a box at the surgery, order online or telephone a local chemist to order the medication. This has made it much more difficult for older people and now local chemists are having to field an exponential rise in phone calls dealing with the workload passed on from the surgery. It also affects patient expectation as then automatically becomes the problem of the pharmacy if the prescription is ordered but not issued.

It’s an absolute disgrace and I cannot begin to tell you how angry it makes me that almost everything relating to GP healthcare is online.

Even ringing is not straight forward anymore for those who may not be technologically able.

It really is absolute disgrace.

Some of the reception staff are also a disgrace and they don’t waiver from the script despite looking an elderly person in the eye over the counter who does not have a mobile phone.

A generation what cannot believe that someone wouldn’t have a mobile or know how to use a mobile.

Get a new phone or iPad. Refurbished ones are cheaper

you can use voice activation to prevent any typing from sore fingers.

a lot of these posts from older people are defeatist! My mum is the same age as you lot and can be self sufficient on her phone

We just have the logins and log in as them.

My DPs never really mastered mobile phones, those they did have a PC before we did to replace DM's typewriter.

The problems are:

• they never expected to live so long. DF's parents died in their 70s, DF is now 96
• they didn't anticipate the rise and speed of technology
• they didn't anticipate all the old perfectly good ways of doing things being removed (no yellow pages, can't visit your bank for example)
• as you age remembering passwords and adapting to new things becomes harder and harder
• as you age dexterity and eyesight also can deteriorate making using mobiles etc much harder

OTOH DF can fix an oven door, still use a lathe, knows how to cut down trees etc etc. Different skills for different times.

It has made me and DH realise how important it is we try to keep up as much as possible, and to keep on top of our house. Our DC won't be able to do for us what we do for DPs.

I think this is only available if you share the same GP practice as your relative? I tried to do this on Monday and that was the blocker. If I’m wrong, I’d be bloody delighted 🙏. Have you found a way round this?

ETA - I’ve now RTWT and can see the suggestions of a second device, apologies!

I am almost digitally native, and also almost 50. My DM taught IT in the early 80s and I grew up in a very tech savvy household, early adopters of all things. DM is now mid 80s and has no obvious cognitive decline - she has done everything online (including running two businesses) since the internet existed.

and yet.

I absolutely hate the digital interactions with the NHS for appointments (though the app is very good for checking notes and ordering prescriptions) and she, who is very active online (newspaper sub via iPad, online banking, just got a fancy new phone with more features than mine) finds it nigh on impossible to get a gp appointment - based on many many frustrating experiences in real life. She ended up in A&E recently after an allergy escalated because she’d not been able to navigate systems to get a GP apt and local pharmacy couldn’t help due to her age.We live at opposite ends of the country so I can’t help enough. I think it’s a really big issue. My own gp’s system is also bad and I give feedback (politely) every time I have an interaction. Automated questions via online forms are poorly phrased and confusing.

I am not surprised people just turn up at A&E as GP appts are so hard to navigate. My kids have absolutely no experience of going to the gp to check up on a concern (which is a lovely privilege of being healthy but also a parent who knows it’s not worth the hassle of trying to get an appointment to check on a concern let’s just hope it goes away) and I worry about what that means long term as - again - it means you’re not likely to know how to treat something minor and just head to A&E with an issue which may not need it.

Perhaps one for @mnhq to set up a live chat with Yvette cooper specifically on this topic?

sorry for rant - not helpful for you OP I appreciate!

I don't, unfortunately, but I'll figure it out.

It seems that you are clueless about some of the realities of ageing. Lucky you.

This is nothing to do with refusing to try or failing to engage with the way the world is moving. My father absolutely did try and he did very well. He has a computer. He has an ipad. He used them both effectively for years. He did online banking for years. He learned how to do online shopping in the pandemic. He has an email account. He was always willing to give things a go.

But at 89, he has significant cognitive decline and he simply can't manage it any more. He can no longer remember passwords and he constantly gets locked out of his accounts. He doesn't understand MFA and can never remember how to access texts on his phone. He struggles to learn how to navigate unfamiliar systems that he hasn't used previously. He doesn't have the dexterity to do it either. And he has totally lost all confidence.

This is not about some Luddite who refuses to move with the times. It is about an elderly man in the early stages of dementia who is struggling to cope with the demands of the modern world.

Perhaps be a little less judgemental. You might find yourself in that situation one day, for all that you think you're "keeping up".

My mum is 81 and has never used a computer. She worked in early years education - there were no computers in nursery or reception classes in the 90s and early 00s. She took early retirement aged about 55. She has never been interested in technology. Dad was more interested and he had a laptop, used the internet, facebook, booked flights and holidays online, but since he died mum is digitally disconnected. She has a dumb mobile phone which remains switched off and in the drawer.

She has an ancient hand me down iPad which the rest of the family can use to send her imessages or photos which she can access, but despite being shown several times cannot send her own messages, Facetime or anything else.

During the pandemic when dad was diagnosed with dementia this made accessing support imnpossible. Mum could no sooner join a Zoom call than fly in the air. Totally agree that for many of us, online is brilliant and convenient. But not for everyone and there must be a non-digital option.

Ridiculous. Surely GPs have noticed that many of their patients are old and frail and some have nobody to help them. Maybe we should all write to our GPs.

My mum is 87 and very independent but I have all her log in’s. She has an iPad and despite macular degeneration and cataracts manages a lot herself. However it’s clear that lots of people that manage and run apps and websites don’t give any thought at all about people with poor eyesight. It’s ridiculous.
we Are constantly trying to ‘future proof’ things for my Mum but then companies re-jig things or her iPad needs updating and we are back trying to teach her a new way to access things herself. If she didn’t have me she would really struggle.

The reason they don’t want everyone calling in scripts is that it takes up a lot of admin time to manage the calls, pass it on etc, and is prone to error. Our gp has 3 options- online form (preferred), call the prescription line and leave a message, or email your request. You can’t phone and speak to reception about repeat prescriptions. This seems to work well.

You should ask your pharmacy about one of 2 options. first option is for them to supply him with a weekly blister back/dosette box (whatever they call it locally) of his medications already made up. They deliver it weekly automatically and arrange the prescription via the gp- your dad would not have to do anything at all (unless he needed more than one week supply, e.g. to go on holiday)- but it is up to the pharmacy and not the gp to agree to this. If it is agreed, the gp makes out the script to reflect that.

Second option is CMS- community management system- where your gp authorises a 6 monthly or annual prescription for all repeat medication. They deliver it pharmacy then automatically issue monthly prescriptions from this. Again, through this system your dad does not need to order his monthly prescriptions as the pharmacy do it. At the end of the authorised y month/annual period the pharmacy contact the gp to ask for a reauthorised prescription to be issued. Again, pharmacies can decline to do this, but in practice most are more than happy to do so as they get an additional fee (and fair enough).

Totally agree.

My ddad was extremely proficient with modern tech - did online shopping, banking, medical requests/prescriptions, forms etc - but with cognitive and physical decline even sending a message via WhatsApp is almost beyond him now - and that's if he remembers to look at his phone and remembers where it actually is or even if its been charged up.

I would not have predicted the level of support he's needing now and do not get me started on facial recognition to unlock a phone or prove your identity!

You're missing the point that with cognitive decline many people who were previously able to manage digital systems cant anymore. My own parents who were great with technology are now utterly cobfused by it

Ypir FIL was a lucky man. If you could see my father who managed a business and was a whizz technically 15 years ago try to do anything online or on his phone , you'd understand what people are talking about. My mother too. She built websites in her 60s and 70s but now is totally confused by WhatsApp or text or emai l