Gransnet forums

News & politics

GPs charging care home residents

(45 Posts)
thatbags Thu 05-May-16 06:27:04

Damning report on the behaviour of some GPs with regard to the treatment of dementia patients in care homes reported in the Times this morning.

daphnedill Thu 05-May-16 16:14:18

One of my sisters was a nurse in charge of quite a large geriatric unit attached to a hospital. Doctors visited the unit every day and there was always somebody on call. The unit had the standard number of qualified nurses.

My sister was made redundant when the unit was outsourced to a private care home company and my sister became an inspector of residential homes. Apparently she's quite harsh in her judgments and becomes quite apoplectic about the standard of care, because she expects them to be as good as her unit was. There are no doctors working directly in the homes, which only employ the absolute minimum number of staff to cut costs. Whereas in the past, nursing staff or the doctor on call from the main hospital would have dealt with many of the problems, a GP is now called or the resident is sent to A & E.

GPs are having to take on extra 'hospital' work or A & E are having to cope with extra demand. Of course elderly patients should receive care, but this model of costs more and there's no extra funding.

thatbags Thu 05-May-16 16:44:46

If the calls for docs are for minor problems that a district nurse could deal with, it would make sense to have district nurses attached to GP practices. At our GP practice one can make an appointment to see a nurse rather than a doctor about various things.

thatbags Thu 05-May-16 16:47:15

It does sound as if part of the problem (the overloading of GP work loads) is that care home workers are not sufficiently well trained and qualified to look after many of the residents' needs.

daphnedill Thu 05-May-16 17:35:34

District nurses still cost money and have their own case loads. They need to be paid for.

daphnedill Thu 05-May-16 17:36:20

District nurses are usually paid more than practice nurses or hospital nurses.

daphnedill Thu 05-May-16 17:43:27

A big problem is that GPs are being expected to take on, without adequate funding, more and more work which would have in the past been done in a hospital setting. Another is that work is outsourced, especially care for the elderly and people with special needs and private providers want their cut. On top of that, the population is ageing and more people with special needs are surviving, so the demand is increasing on top of everything else. The fact is that if the UK wants a health care system like (for example) France it needs to pay approximately another 25%.

Gaggi3 Thu 05-May-16 20:01:29

Sadly, I do believe that some doctors have financial interests in care homes, though I hadn't heard of it before. I think it shouldn't be allowed, just as I think MP's shouldn't have financial interests in drug and medical services companies.

thatbags Thu 05-May-16 20:11:18

I get what you're saying about GPs work loads, dd, but I was under the impression that in the past (my childhood, mid-sixties) GPs did a lot of little jobs that then got foisted onto hospitals. For example, when I was eleven I escorted a younger child to the GP surgery up the road from my primary school so that the doc could look at, and put a stitch in if necessary, a torn ear-lobe. The escorting part by a child (I was a responsible one and nothing went amiss) wouldn't be allowed nowadays but, that aside, GPs haven't been putting stitches in cuts or bandaging injuries for yonks. Back then they did. Now it all goes to A&E. Maybe it's turning around again. It's work better, like most of the rest, if there were more doctors, of course, but there weren't enough doctors being trained when my brother went to med school, so people said.

Yes, I know district nurses (or any other kind) have to be paid but they don't have to be paid as much as GPs but they equally capable (moreso in some respects) on quite a few health matters.

Yes, I also know there isn't enough money in the pot.

thatbags Thu 05-May-16 20:12:12

It'd, not it's

thatbags Thu 05-May-16 20:13:38

And there isn't enough money in the pot because we, including our government, don't put enough in, or else it gets wasted.

durhamjen Thu 05-May-16 20:22:49

A person is either in a care home or in his/her own home. It's still the same person, and usually in the same district.
There is no extra burden as far as numbers are concerned. If a GP is charging for this, it should be illegal.

durhamjen Thu 05-May-16 20:45:22

This is where the money goes.

daphnedill Thu 05-May-16 21:13:31

dj, People are in care homes, because they couldn't cope at home. In the past, some of them would have been in a hospital ward, where they would not have been the reponsibility of the GP. To be brutally honest, they would have received better medical care, BUT most people don't want to be in a hospital setting. Care in the community or in a care home comes at a financial cost and somebody has to pay.

I agree with you that some of the money is going into private profit, but don't kid yourself that's the only reason there's a deterioration in services. As a country, we just don't pay enough, compared with other developed nations, for the health and social care system we want.

thatbags, Diabetes and mental health are two big areas of the NHS, in which GPs are expected to do much more than they used to. They're also expected to do more preventative medicine, such as heart disease and obesity screening. PS. I've had various bits of me stitched up and I don't ever remember not having to go to A & E.

durhamjen Thu 05-May-16 21:37:37

You mean like my 94 year old mother in law, Jalima?
She's now in her third carehome over two years, her dementia getting worse all the time. What I am saying is that it's just the one person, whether in a home or her own home. The GP who looked after her when she was in her own home no longer has to look after her.
It's actually more cost effective for GPs to visit care homes, as quite often there is more than one to be seen at any one time.
Over the last month or so my mother in law has been in hospital - on a strike day - for six hours, has fallen out of her chair twice and now has a very nasty chest infection. That would possibly have happened wherever she was. It's just that when she was in her own home, she lay in the garden for a couple of hours until a neighbour heard her.

durhamjen Thu 05-May-16 21:38:19

Sorry, Jalima. I mean daphne.

Bez1989 Thu 05-May-16 21:46:54

"They" are working at keeping "us" to live longer with no thought to our medical needs and the costs involved. I dont want to "live forever" thank you Freddie !
I cant see the purpose to be quite honest.

daphnedill Thu 05-May-16 21:50:42

dj, No, it isn't more cost-effective, because if the care home weren't there, she'd be in hospital. This might be more cost-effective from the NHS's point of view, but it's offloading extra work on the GPs. People in care homes generally have much higher care needs than people capable of living on their own. The homes should be employing qualified nurses to deal with many of the needs as part of the care package, but often they don't or the only qualified nurses are expected to take on management and admin roles and don't have the time to treat the residents personally.

GPs aren't supposed to charge if they are called out on a normal home visit, whether that's in a care home or at home. However, many of them do regular visits, just as a consultant would do a ward round. While they're there, they should review medication and treatment in addition to ordering tests and treating minor ailments. Ressidents and staff can bring up any concerns. This is classified as an 'extra service' because people in their own homes wouldn't receive that level of care and they are allowed to charge.

Crafting Thu 05-May-16 22:05:02

* Durhamjen* I know what you mean about it just being the one person whether in their own home or in a care home but that's not necessarily so. If a large care home is built within a GP practice area then the patients can move in from miles away not always local people.

In the case I mentioned in an earlier post the 90 patient home was built on the site of 4 large derelict houses so the surgery had to cope with 90 dementia patients only a few of which were local people.

durhamjen Thu 05-May-16 22:13:17

But she couldn't be in hospital for two years, daphne, which is how long she's been in a home.
The problem happened when council care homes were closed and it was handed over to the private industry. Many carehome groups are owned by venture capitalists, not individuals who are interested in elderly care. They thought it was an easy way to make money, whether from the council - my mother in law is 100% funded now - or from the resident.