Relocation

[Undercoverbanana]

I wonder if anyone could settle a niggling worry I have, please?

Widowed, elderly Dad is moving to be closer to me (only child) as he is not coping. It is 100 miles.

I have done all this before with my Granny (Mum’s Mum), so am not worried about selling a house, finding somewhere suitable, dealing with finances, insurances, GPs, dentists, changing addresses on bills, selling possessions etc, etc. Not fazed by this one bit.

What worries me with Dad is the following.

Unlike my Granny (who was fit as a fiddle in her mid 90s), my Dad has so much wrong with him. He is under the local hospital for so many things. Neurology for cognitive problems, Oncology for cancer, Urology for prostate and catheter problems, the Memory Clinic, regular injections for the cancer, medication for bowel problems, constant spinal pain that is under investigation.

Can the local hospital say he is too much of a burden and refuse to take him on?

How does a transfer to a new health authority work? Do all these departments have to do different things or is it just a simple transfer like transferring a bank account where everything continues but in a different place?

What action do I need to take with regard to this side of things and how can I make it easier?

Obviously his health is complicated and I don’t want delays or complications with ongoing meds, treatments or cancer procedures.

Any advice gratefully received.

MIL is 88, housebound with mixed dementia and a number of physical problems. We have recently had to change her GP and it was made clear as part of the change process that the new GP could decline to take her on. That didn't happen though and they have been very good with her so far.

I would imagine in your case you would need to get your DF a GP in the new area and at the initial appointment ask for referrals to the hospital. What I don't know is what happens to hospital notes, whether they get transferred in the same way as GP notes. If they don't, it would be useful to follow the procedure on the current hospital's website and get a copy, otherwise I suspect continuity could be a bit of an issue.

NaToth - This is what I was afraid of.

We can’t get him with a new GP until he can prove his address here, but his cancer treatment Is very carefully timed for effectiveness. Surely there are special procedures for ongoing, life-preserving treatments?

Elderly people move to be closer to family all the time.

Who could I speak to? Is this something Age Concern could help with?

Also - he is likely to be moving in with me temporarily until his house is sold, so can’t prove a local address for a GP.

Shit. This might be bloody messy.

If he is moving in with you, and will have no other address at that time, then you should use your address. It's his only home.

I suggest you write/email existing GP to set out the logistics of what ongoing treatments need to be arranged prior to his move. Suggest a transition period of say 6-8 weeks, where you complete the registration with new GP at your address, before he moves house.

He should continue to receive treatment under existing arrangements while he visits you to have initial registration appointment with new GP.

Call the secretary for each specialist he is currently under. Ask them to write a referral letter detailing current treatment plan. They should not stop treatment until your dad contacts them to cancel his next appointment. Only do that when his new treatment plan is set up/first appointment confirmed with new consultant.

He should not move until he has a plan for his ongoing treatment. Keep his current GP informed, as they will still be able to treat him after he has officially moved practice. He'd be classed as a temporary visiting patient.

What on earth happens to elderly people who have no-one to help them with these things?

There is no way my Dad would be able to do all this. His cognitive abilities are absolutely shot.

I am going to be using my POA soon as he can’t cope.

I can handle bureaucracy but many old people can’t.

Whatnow40 - thank you for this.

It sounds unnecessarily complicated but I can handle all that.

Why on Earth can’t the NHS just do a transfer, like a bank would? It’s 2019 for goodness’ sake.

As an NHS worker it's pretty common and for a consultant to refer to another hospital when a patient relocates and copies of relevant information can easily be sent. Hospitals can't turn patients away and to be fair the way funding works it probably benefits them to get a new complex patient.

As for what happens to those with no help, its a real concern. Having a health condition sadly does require a lot of life admin skills especially when multiple departments or hospital sites are involved, appointments can change at short notice and admin failures do mean things like scan appointments, test results and follow ups often have to be chased by the patient.

There are loads of people who are elderly or with intellectual disabilities who live in the community with no or token support who can't cope with this and miss out on healthcare as a result. Us admin folk do what we can but it's never enough.

NHS admin is still in the dark ages. Email is very taboo to a lot of departments.

OP, I don't have experience with this but have experience of something else relating to a GP

they've said that a relative can sign up for the GP under the address of the existing patient, and that treatments can be transferred via referral letters.

Do you have any central points of contact for your father's care? Sadly a lot of NHS trusts don't seem to do email so it will be letters I think. It's bonkers.

There's info here about registering with a new GP
www.nhs.uk/using-the-nhs/nhs-services/gps/how-to-register-with-a-gp-practice/
They're not allowed to refuse you for medical reasons.

There's also stuff which I haven't read which suggests not having an address is not a valid reason for refusing to register.

I don't know if it still applies, but at one time if you couldn't find a GP, the NHS could just assign you to a GP, who had to take you on.

Thank you for all your advice here.

I am going to have a chat with my GP surgery today to get the basic information I need.

I am attending my Dad’s hospital appointments with him from now on as he can’t remember what/where/when/how etc, so can ask questions at every stage, including the relocation process.

No-one warns you how much work this causes. I have a full time job and am marathon training and also have homeless shelter commitments. Dad is 100 miles away and frightened.

I need to be able to help him enjoy what life is left for him and not have him distressed and confused all the time.

No-one warns you how much work this causes. Yeah, it's easy to think of the washing/feeding/house cleaning, but you can get people in to do all that stuff. It's all the management/admin. Dad's neighbours may see me go round only 2-3 days a week, but I'm spending another 2-3 days doing all the background stuff.

oh I thought Banana meant the work caused by moving areas and local health authority....

oh I thought Banana meant the work caused by moving areas and local health authority. Yeah, that's one example of the background work. But she's also talking about attending appointments with him, and once you start that, you get all the work of chasing up referrals, chasing up results, making sure repeat prescriptions are ordered, and it just gets worse from there. Even though a lot of it is phone work and can be done from a distance, it's still time consuming, and something I think people without elderly parents don't think about.

Can you go and see a GP surgery and explain his issues and that you want to register him as a temporary patient because he is staying with you? Then you can assess what the surgery is like and when the decision is made to have him living near you then you can ask to be permanent if the surgery suits him?

My local surgery will only take temporary patients for a maximum of 2 weeks, then they just drop them.

They also said that they need proof of the local address (he won’t have anything because his proper home will still be his own home, 100 miles away).

Also, they need photographic ID. His passport expired years ago and he’s never had a driving licence (Londoner, so no need for a car).

Aaaaggghhhhhhhh.

I’m already having to attend his appointments. I am using up all my holiday entitlement.

Age uk may be able to help you navigate this. Good luck.

Used to work in GP practice, speak to Practice Manager about taking your Dad on as a permanent patient, with such a complex medical history they will need his medical records in order to provide his health care. Also at the practice I worked at we had some temporary patients for longer than two weeks at a time , again speak to Practice Manager. Does he have a bus pass with his photo on and could they accept a letter from you to say he is living at your address at present. Good luck with this , I hope you have a compassionate GP practice who will help you through the process.

Practice Manager would not make exceptions. I explained all his illnesses and even used dark humour by saying “he won’t be anyone’s patient for many more years”.

Can’t find an expired passport and Dad can’t remember what a passport is because he’s confused.

I went to open a bank account for my father the other day, and they accepted the power of Attorney document as being sufficient id for him.

(Still wanted passport for me, though).

The Practice can't turn you down without good reason, which they must explain in writing. The link I gave above gives the reasons they are are allowed to turn you down. Admittedly one is that you're out of area, so not being able to prove you're in areas is a problem there. But might be worth writing to them quoting that they must accept him unless

" it has no capacity to take on new patients
it may not be accepting patients that do not live within its practice boundary
in his particular circumstances, it may not be appropriate for him to register with a practice that is a long way from where you live"

and reminding them that refusal must not be based on
"race, gender, social class, age, religion, sexual orientation, appearance, disability or a medical condition", and reminding them of the requirement that they must give reasons in writing. It might make them stop and think instead of taking the easy route.

Alternatively, get in touch with your clinical commissioning group, or try the NHS contact centre:
www.england.nhs.uk/contact-us/