GPs to stop providing care to residents in care homes

[hiddenhome2]

Guardian link here

I work in a care home and I'm finding this quite shocking.

My elderly mum is currently suffering with very bad back pain and a few weeks back we had to take her to an out of hours clinic a 40 min drive away. And she lives at home with my dad. She was lamenting about the 1970s/80s when doctors would come to see you at home. God knows what an elderly person living on their own would have done Luckily my dad still drives.

And now they wont come out to those in care homes either.

I don't know how people are going to manage. The elderly are vulnerable to all manner of illnesses and recurring infection.

What about end of life care as well? Are these people going to have any symptom control at all?

This has the potential to cause mass suffering.

I'm not easily shocked, but I'm finding this very difficult to understand.

YY Hidden What if some poor elderly person is left in pain?

It will also increase your workload.

If GPs are already reluctant to visit patients in care homes, it's going to be safer for patients to have some other medical service to look after them. (god knows what.) Reluctant GP care is not safe.

The article says GPs don't feel able to provide care for people who may have been discharged into the community too early or in fact needing more specialist input. They need to practice safe medicine, I think that's being responsible.

There isn't going to be anything to replace them though.

Do you think that the owners of care homes will be willing to pay for a locum?

Ive seen posts on MN before about elderly people being discharged too early and in some cases in the middle of the night.

Well hidden home going by the wages care workers are paid i highly doubt they would fork out for one.

Yes, they can be.

We received a man back into our care once at 11pm. He was extremely distressed and died within half an hour of arriving back to us what a way to end your life

The public don't know what goes on.

This group of people are at extreme risk of neglect.

How on earth can we nurse people with no access to medical care?

The living wage is coming in too, so carers will be paid more and care home owners will have to find the money for this.

Many elderly people have no one to advocate for them.

They arent a trendy enough cause Hidden!

Indeed

It's outrageous. I started ranting at my DP in the middle of the Co-op when I saw the headline. (I'm a social worker for older people.) If care home managers need to employ private GPs, it will push up the costs. This will cause significant issues for those who are in local authority funded beds in care home. Local authorities already are paying the maximum that they can afford, there are cuts to social care and we are a rapidly aging population. People who live are living with complex and chronic health problems. In short, the costs will be lumped back on to the individual; self funding residents will be paying more and local authority funded residents will have fewer care home options or be asked to pay the difference. Dignity in life for older and physically disabled people is slipping away and I wonder how many people actually care. :(

The thing is, folk in care homes are much more I'll than they used to be. Ten years ago the same people would have been cared for in hospital, under the care of a geriatrician. GPs don't necessarily have the skills to care for them. Hospital based geriatricians should be supporting the care of these people imo.

Its appalling. OK, I can see they don't need to see everyone in a care home everyweek (if that is indeed the requirement), but people who live in a care home should be just as entitled to proper care as anyone else.

Do they think we should be going back to the days of the geriatric ward where people just stayed in a hospital bed?

My parents are both very frail, and both have been discharged home inappropriatly at all hours, including recently dad got sent home by transport at 1am and couldn't get in the house as he couldn't see the keysafe - they just left him on the pavement, didn't take him to the door with a torch. He slept in the shed all night.

I was thinking about this and there is an issue, imho, where care homes, like any institution eg school, must have everything ok'd by someone who is an authority in their field.

So little Jimmy bangs his head at school, in the past the teacher would check over and if ok send him back to class (what you would do at home, keep an eye on him). Now I doubt they'd dare do that as if something should later happen to Jimmy (feels faint etc) teacher is RESPONSIBLE and could even be hounded from her job if little Jimmy suffers seriously.

Again the Care HOme. Say elderly mum lived with you, she slipped and fell, big bruise on leg but YOU know a trip to a/e etc woul distress her so you keep an eye on her and as there are no ill effects leave things to heal. Perhaps getting it checked next time doc calls in a few weeks time.

CAre HOme MUST BE SEEN to CARE - Injury must be recorded, however trivial, so docs/ ambulances/ etc etc MUST BE CALLED or they risk being sued by the family of the elderly person if there is later illness (even if slight connection).

So the upshot is Docs called all the time.

My poor DM was sent into hospital in her last days by a GP, from her Care home - I've no idea why, was going to tackle GP about it after she'd passed away a day or so later, but felt it was pointless. She was dying, but why couldn't she do that in the home? Why didn't I know until she was admitted to the hospital. I suspect the CAre Home was not wanting to deal with her death there.

I'm not quite sure I believe it will happen as many local authorities have set up dedicated teams from GP surgeries to visit care homes, and they seem to work well. if GPs won't come out then many more older people will end up back in hospital, the worst place for them to be and at huge expense to public funds. I don't think the government will let this happen TBH.

CMOT that is utterly shocking.

This is odd.

They don't see residents one or twice a week routinely, why would they?

They see them if there is a change /concern/ new symptoms just as they see people who live at home and are housebound.

General ongoing care is not the same issue as people being discharged too soon. And as someone who is regularly in charge of one, of course we can use our judgement as to whether or not an ambulance /go/other service is needed, that's my role

The headline is a little misleading - if you read the whole article tucked down in the body it's says that the vote was to lobby government for changes within the GP contract negotiations about the services they provide to care home residents. The problems are more and more complex elderly care issues in the community but no extra resources to provide those services, therefore GPs are struggling to provide them and cater for the General practice that they are set up to provide. There is another article in the subject that clarifies their position somewhat www.theguardian.com/society/2016/feb/01/gps-urged-to-continue-visiting-patients-in-care-homes

I see the other side of this. Last year, my very good GP practice held a consultation exercise with all of us patients because of the issues caused by covering a very large Care Home near the surgery.

First, they had no option to refuse to provide care on the grounds of capacity-as the residents were within the practice boundary, they had to take them.

The Care Home refused to pay for any enhanced service, although many residents had complex needs and should have been in specialist care, had any places been available.

To save money, the local authority was not providing the Care Home with several key services like district nursing, so the burden on GPs was even worse.

Some residents didn't even have a medical summary or management plan.

The whole thing was awful. The GPs were overstretched and clearly unhappy about the terrible treatment of vulnerable elderly people, as well as having to give a sub-standard service to other patients. They were more than happy to treat the residents if a proper plan and resources were put into it.

It really wasn't about GPS being unreasonable, selfish or uncaring, in our case. Quite the opposite.

I fear GPS will be made to take the flack for the fact that local authorities have cut social services to the bone and dumped people who need high levels of care in ill-equipped general care homes, whose owners won't pay for appropriate care because it eats up their profits.

Everyone in this country wants elderly people to have good care, no one wants to pay for it or even admit how much 'good care' actually costs.

"I fear GPS will be made to take the flack for the fact that local authorities have cut social services to the bone and dumped people who need high levels of care in ill-equipped general care homes, whose owners won't pay for appropriate care because it eats up their profits."

Precisely.

That's awful. The problem is doctors would quite happily see patients registered if they could come to the surgery as "normal patients" but the cost to a home to arrange transport and one or two carers depending on persons needs to pop off for hour or so is just not affordable.

Then you have real frail and complex cases where they can't do a lot but tweak medication but because are in care setting don't have acess to other end of life or nursing care services.

There is a pattern to these stories, whichever party is in power. It goes like this:-

Legal aid/access to justice crisis: fault of greedy lawyers.

Elderly care/working hours/cancer care targets crisis: fault of out of touch, unreasonable, demanding doctors.

Train drivers strike over serious safety concerns: fault of Bolshevik trade union wreckers.

Education worse than other developed nations: fault of rubbish, overly PC leftie teachers.

Maybe. But sometimes, just sometimes, the people who actually work in a sector are genuinely trying to tell the rest of us that something is wrong, things need to change, yes we are desperately under-resourced.

This is sad news. The GP who visited my DGF's care home went above and beyond for him several times in his last few months and said he would always come out and see him at the care home any time they were concerned and the care home staff were to always to get him to come out first before taking DGF to hospital. He didn't want his elderly patients to be dragged through the stress and infection risks of a hospital A&E unless it was essential and treatment was needed that he couldn't manage at the care home for them, in which case he'd arrange it so they could go straight in and come straight out. Not to mention the difference of being treated by a familiar trusted person.

It made a big difference to DGF's quality of life in the last few months and I'll always be grateful to that GP. With hindsight I suspect it was one with a particular passion for geriatric care, he was brilliant.