GPs to stop providing care to residents in care homes

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Guardian link here

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

Most non LA care homes are run for profit aren't they? I thought it was now a heavily invested in sector for return of funds? So I think it's EXTREMELY important to listen to how little the carers get paid and how the conditions are in these homes

Sorry if that's controversial but the vast majority of us or our relatives are going to be reliant on care at some point, so it should be important to all of us.

I think it's short sorted to blame GP's

My elderly parents' GP is worth her weight in gold.

I'm sure that no decent GP wants this.

"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."

Agreed but equally, NHS Continuing Healthcare are declining more and more people who used to be eligible. Therefore, social care has to pick up the slack. We (adult social care) are funding people whose primary needs are health related.

MyFavouriteClintonisGeorge Public services are underfunded and being cut. The result is shifting blame. The GP says: "if the social worker had got a care package in place, perhaps Mrs Smith would not have fallen and broken her hip". The social worker says: "if the GP had investigated Mrs Smith's dizziness and found her blood pressure problems, she would never have fallen in the first place". The GP is not blaming me, he is blaming 'the system' because Mrs Smith has sat on our waiting list for 2 months; not enough social workers in our area because the job is shitty, stressful and poorly paid. I am not blaming the GP, I am blaming 'the system' because if he had a manageable patient list, he would have time to do that home visit.

We are certainly not all in this together and frontline workers see this.

but the vast majority of us or our relatives are going to be reliant on care at some point, so it should be important to all of us

I don't think that this care IS going to be there. It's too expensive.

Families are going to have to step up to the plate.

Looking back, my DM could have moved back in with us from the Care home once she was unable to get about (and leave the gas on/ go outside and get lost) and spent most of her time dozing in her chair. It's assumed residents will stay in Care homes until their deaths but as some people live into their 100s this is a hugely expensive expectation. By the time residents are in their 90s or 100s their DCs are retired, then there is less excuse not to have them stay with you. Obviously if they are severely disabled visits by carers might be necessary but that is prob cheaper than a care home.

GPs are worth their weight in gold, and if care homes have to emply their own GP, then they are effectively becoming a privatised "nursing home" via the back door.

My DGM (92) was discharged to her own home (not a care home) after a stay of several weeks in hospital. She lived alone but my mum (her DIL) was there to meet her when she arrived. The hospital driver who brought her back said to my mum her didn't think she should have been discharged.

She couldn't cope by herself, despite the "care" put in place, as she had dementia. As my DM was also looking after her own mother (aged 97 and in her own home) she had to be moved to a care home. She was later re-admitted to hospital for SEVENTEEN WEEKS while all the care homes in the area refused to take her in due to her dementia being so severe. Eventually a place was found that could cater for her needs, but sadly she died a few weeks after moving there.

SsargassoSea I take offence at your comment that "families are going to have to step up to the plate". There is nothing more in the world my parents could have done for both sets of their elderly parents, whom they cared with great love and compassion for until they could no longer cope.

My dad aged 10 years in 24 months whilst he and my mum cared for his parents as they slowly deteriorated and died.

My mum was eventually limited for over a year to two-hourly time periods "off" between visits to her mother until she died.

It nearly broke them. They lived not far (6 miles for one set and next door for the other) from their elderly parents. Their house would not have been suitable for two nonogenarian women, one of whom had dementia, to move in and "doze in a chair" smash stuff up and self harm. They needed the night times, which they spent in dread of the constant telephone calls, to themselves.

Sadly I live more than 100 miles from them. They dread getting ill and dependent on me and my brother. They had no time to see their grandchildren growing, and no time for themselves or each other. You cannot say that families like this are not stepping up to the plate because they can't take in their elderly loved ones. My parents are not the only ones caught in the middle here. Countless are in the same situation, as I have seen posted here on MN many times.

Now that both of my grandmothers have sadly died, my parents are able to have a small amount of their lives back. My mum came to see my DDs in their nativity play, which she could not do before. They visited my sister, a couple of hours drive away, for the second time in 10 years. They can go for a meal out, or to buy new clothes in their nearest large town, 15 miles away, for an afternoon...

It took me ages to type this post and I am sure that there have been many others since SsargassoSea at 20:05:10 but the elderly are a different kind of issue that needs to be on our radar. We need to get a solution in place.

I should add that in total, my parents have been "carers" for their own parents for 10 years. The last 5 were the worst.

A couple of things spring to mind -

1. Could not-for-profit nursing/care homes be part of a solution? (Btw did there used to be NHS ones?)
2. I wonder if the claim that these patients require more specialist care might set a precedent - I'm thinking specifically of mental health issues, with those services decimated and so much of GPs time taken up with MH issues which they have little training in.

"Families are going to have to step up to the plate"

a. a lot of family members have moved to look for work (and there is no shortage of ppl cheering this on in RL and on this site)
b. Employees rights have been eroded. You have to be working somewhere for over 2 years or more before you can be dismissed easily and even then with no legal aid you have got to afford to be able to file an unfair dismissal Not to mention zero hours contracts.

In theory carers and family members can ask for flexible working but wont necessarily get it and the way rights are being eroded its very easy to sack someone while pretending its for another reason.

This climate is not conducive to your suggestion Sargasso.

We cant have it both ways.

Locally the hospital trust is funding intermediate care beds in care homes, which is the kind of answer that I think will eventually be found. I wonder what's happening in Manchester where the health and social budgets were finally supposed to be being merged (and I truly admired this government for ?achieving this, as it's been talked about for at least two decades that I know of and probably more).

It may be that the end of the antibiotic age will eventually solve this by reducing age expectancy again - but there will be a HORRIBLE patch in the meantime where generation Xers find that there's nobody still alive in their families to look after them. It might mean that people have more conversations about when to stop treatment and what kinds of treatment to stop.

This

Hospital and gp services at breaking point all engineered by govt who cut funding. There are no private GPs in my area, in fact very few at all and too few in the UK and many leaving to retire . If you don't fund a service, you won't have a service, simple as that.

It's time to stick up for junior Drs and the NHS . It's been coming for a while and now it's nearly here, but no one has been listening.

And GPs do still do home visits .

pookamoo your experience is the tip of the iceberg I'm sure.

Was your DGM self funding? Would she have been given a place if she had been?
My suggestion - that if elderly relatives are no longer a danger to themselves or anyone else they can be moved out of the home - might have meant there was a place for your DGM.

Currently the Daily Mail and other government propaganda/Murdoch rags are spinning against Doctors (whether junior or GP ferociously). It is a puzzle why we have become a target. Is it because we are relatively left wing as we work for the NHS, a splendid example of Socialism in action? And not afraid to speak out.

General Practice is in crisis due to increased demand inadequate funding and shortage of qualified GPs. Visiting one patient in a care home takes up as much time as seeing about six patients in the surgery. To try to relieve some of the demand GPs are suggesting other arrangements be made for Care Homes eg Care of the Elderly specialist to do a weekly visit or Community Matron to coordinate care. This is being spun as "GPs refuse to visit care homes".

What to do? Don't believe everything you read in the paper. And don't vote Tory! And pray the NHS can survive the attempt to destroy it and sell it off to private health care companies.

They have NOT voted to 'stop providing care' to care homes, they just want to renegotiate the contract, and therefore funding, under which they provide care to residents.

Jeremy Hunt and Simon Stevens want to deliver more healthcare in community settings to free up/close hospitals to save money. Care home residents who previously would have been long-term hospital inpatients costing £400+ a day are now under the care of general practice, who receive around £140 PER YEAR per patient and are expected to provide the same level of care.

GPs want a separate contract that takes into account the additional needs, time and complex comorbid conditions of care home residents. There is a recruitment crisis for GPs (which isn't going to be helped by the new junior doctor contract) and there just isn't the funding for practices to recruit the GPs they need under the current arrangements.

It's not just elderly care. GPs are being expected to pick up the slack from cuts in all areas, from mental health to cancer to A&E. There isn't enough funding, plain and simple. If they carry on as they are, people will die.

Which is why I mentioned care homes being run for profit, but it's been ignored. Care home run for profit need to pay for GP visits imo. They charge residents @ 1k a week and pay their staff pennies

Personally I am of the opinion that a care home's costs should include a doctor and a nurse on site 40h per week each. It seems utterly bonkers to house a load of elderly people, most with failing health, downward spiraling mental health and, usually, less that 5 years left of life, and not think that on site medical care is necessary.

To me its like not having a teacher in a school.

I work in a really good care home in Germany (I am told there are rubbish ones here too - its not my background so I only have the one I work in as experience).

What stands out here is it sounds as though in the UK all residents of one care home are registered to one practice - can that be right?

Our residents are all from the local area, and they stay registered with the same GP as when they lived at home. The GPs visit the home on an ad/ hoc basis - we have about 130 residents and GPs will do calls to see a group of residents, but will also come to see just one if called. Dentists and chiropodists and occupational therapists and all sorts of professionals come in to, as do various priests and so on, to visit members or ex-members of their congregations...

We also take them to the GP or dentist etc. if the resident wants - some of them like an outing and ask to go to the dentist of doctor unnecessarily for the outing

Are whole care homes registered en-masse to one practice in the UK, meaning some GPs have no care home responsibilities and others are overwhelmed, because of where the care homes are situated?

As an aside most of our residents like to return to the care home to die - if they know they are dying in hospital they ask to go back home to the home and are allowed - we have people on palliative care... :(

No, most homes have residents registered with several practices. We also encourage /accept residents back for end of life care. I discourage Dr's from sending people in if they are obviously dying, but sometimes the family is unrealistic We would much rather people are cared for by staff who know and care about them.

Ah that's good SecretSpy - I wonder why it is any different for those GPs than it would be if those patients were being cared for at home then? Do GPs no longer do any home visits?

They do still do home visits, but as few as possible, because they can see a lot more patients in the same time at the surgery. So visits are usually restricted to people unable to come in because they are housebound etc.

Unfortunately a few people are 'housebound ' but just manage to visit family and do shopping if someone takes them but I think most GPs know who genuinely needs one.

GP's aren't objecting to providing care, they are objecting to the number of patients on their lists being dramatically swelled by patients being dumped out of hospital care.

Surgeries are stretched to capacity as it is, and now they are getting hundreds more patients to care for and administer with no extra resources being provided. They physically can't do it, but they are being demonised for freaking out.

How would a school teacher with 30 students feel if she was told that from next week she will have an extra 10 students in her class, but no extra resources of any kind, and just to get on with it?

There are many economic reasons (e.g. people having to earn money to live, move for work, and work until an older age) that will make it less and less possible for families to 'step up to the plate'. Also demographic ones - the assertion that by the time a parent is in their 90s/100s their children will be retired - will also often not hold up, due to a combination of people having children at an older age and ever-increasing ages of retirement. On my mother's 100th birthday, if she lives to see it, I will still be in my 50s. As it happens, I can be around to care for her, but only because we live in a part of the UK where the cost of living/housing is much lower. I will pay dearly for it in later life, as my career is now down the toilet.