GPs charging care home residents

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.

* 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.

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.

"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.

Sorry, Jalima. I mean daphne.

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.

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.

www.opendemocracy.net/uk/andrew-dolan/britains-care-homes-have-been-turned-into-complex-financial-instruments-how-could-this-possibly-go-wrong

This is where the money goes.

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.

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

It'd, not it's

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.

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.

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%.

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

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

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.

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.

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.

If we are talking fee paying care homes, don't forget the people who own them are charging lots of money to have people in their care. We had a dementia care home built near our surgery and in the space of a couple of months the GP surgery had 90 new dementia patients to care for along with sorting out all their medication and other needs. The staff in the home were not willing to bring any of the patients to the surgery for treatment and in many cases were unable (or untrained) to cope with any minor problem. The surgery received phone calls from the home several times a day asking a GP to visit to see anything from 1 to 7 or more patients who had a range of minor problems. GPS had no financial interest in the home and received no additional payment from them. All the money went to the owners of the home who employed cheap unskilled labour instead of properly qualified staff. Hence the huge drain on the surgery resources.

Whilst I am sure there are GPS who are charging, it is not the case across the board.

Having worked in practice management, I would agree with Gaggi3 and Damnedill.

Our local nursing homes demanded a half day attendance every week, regardless of whether their patients needed it, and would expect doctors to do all sorts of additional work whilst there. The surgery needed to cover its costs by providing these services, but actually the fees agreed didn't come up to the mark. Woe betide the GP who tried to leave a bit early to get back to his/her patients!

I was a GP and knew many others. None of the GPs I knew had any financial interest in care homes.

TriciaF, it was also discussed on You and Yours a few weeks ago. A care home resident was applauding the fact that, if she needed a doctor to visit her, she never had to wait. Perhaps that's why the rest of us can't get an appointment for a fortnight.

This was discussed on You and Yours this lunchtime, and if it was fair reporting, it sounds as if most GPs are already overstretched, without having to cover full sessions at Care Homes.
Ideally Care Homes would have their own GP, specialised in the care of the elderly, but it doesn't seem this is likely to happen, because of the shortage of GPs.
Recruiting campaigns don't seem to be having much success.

Gaggi one GP I worked with owned 2 care homes so it does happen.

The teams of nurses are the district nursing team and as an area near me is starting to look like one big sheltered accomadation/ care and nursing home there is more pressure on the nursing and doctor team.

Relying on telephone consultations must be difficult for the slightly confused still living at home. How do people with hearing loss manage. Will they be charging us for home visits? I feel a bit sad about the future but realise the medical profession must be under great pressure and want a salary equal to other professionals.