GPs charging care home residents

So, once again, it's the old and vulnerable who get the thin end of the wedge.

It's rather a sickening story, isn't it?

It's a damned disgrace and about time that such negligence was treated as criminal and these peope tried in court.

I appalled at this but somehow not surprised. For many years now GP s have been asking for additional payments from the NHS when large care homes open on their patch. In the past some of the larger homes have paid them a retainer (which of course they passed on in the fees) but this seems to have ended now. These patients are fully entitled to all NHS service free and what needs to happen is that the homes should be advocating on their behalf when the GP tries to charge and report them to the local commissioning group. I hope this article stirs things up!

Someone needs to take hold of the NHS and make it fit today's world then this would not happen.

There has been no forward planning for an aging population and their needs. We have 'virtual' wards round here and they seem to work well as they operate in a holistic way but the cover is patchy.

I'm ignorant enough to be shocked by this.
I'm also sad and disgusted.

Angry, sad and despairing in equal measure. If it doesn't impact us directly now (e.g aged parents or perhaps partners) it surely will and I would rather not look ahead to that day.
My DM and MIL both died suddenly and however saddened and shocked we all were by their loss, in hindsight we and we were spared much suffering

"We and they were spared much suffering"

Perhaps they would do better to have local teams of care home doctors and nurses specially recruited to provide these services for elderly care within a particular area.
I can see how a lot of care homes in one area could impinge on the work of regular GP services.

It's a grey area. Private are homes often employ GPs to do 'rounds' - they're there on set days every week and the homes pay them a fee to provide the service, even when nobody is actually in need of a GP. Sometimes private providers are used. If a resident needs emergency care, they should then see a GP for free.

That care home residents should be able to see a GP for free in non-emergencies as well is, I think, what the article is saying. The fact that someone is old, has dementia and lives in a care home shouldn't make any difference.

It is not the fault of the old people needing doctors that there aren't enough GPs to go round.

Plus, I wonder how much 'shoddiness' there is in the approach of some GPs and
locums. Yesterday I heard from a ninety-five ear old woman (96 this month) who had a scratch on her leg go septic. Her home help arranged for a doctor to call in the evening. According to the 95yo, no doctor came. According to the doctor he came but no-one answered the door so he went away.
Scenario: doc has been called to deal with a septic wound on a very old person; no-one answers the door; he buggers off.
!!! No checking the door to see if he could get in or any other practical action taken.

Patients with dementia (or any other patients for that matter) should be able to see a GP for free, wherever they live. What I'm saying (and I know this happens) is that GPs are sometimes booked to make regular visits to care homes, whether or not they're needed, in which case they charge the home a fee. You wouldn't expect GPs to visit all their vulnerable patients at home, just on the off chance they're needed.

I had elderly neighbours who constantly called the GP . The practice left a notebook on the mantelpiece and wrote time of the visit and what advice had been given. I suppose it was before we recognised that dementia had set in.

If we look back through our lives there will almost certainly have been long periods when the only reason to see a doctor might have been for a repeat Pill prescription or for a poorly child. If you are lucky, from your 40's through to your 60's you may not need to go at all! This should balance out the demands of elderly patients' needs. All things being equal. Of course with an increasing elderly population, because we are surviving the illnesses which bumped off our grandparents, there is greater need, so why does a government with all the bean counters at its disposal not work that out in advance?
It's like building houses for young couples and then wondering why 5 years later, there are insufficient places available at local schools.
It's called forward planning, but piss-ups and breweries spring more readily to mind.

True. It should have been planned in advance and not left for the current working age population to pick up the bills.

And how many of these Doctors own or have a stake in the care homes they are 'visiting'.

It is important to understand the impact of care homes and the demands they make on already overstretched GP practices. Of course everyone is entitled to care but there aren't enough doctors to go round. I have an interest as DD1 is a GP and know how difficult it is to recruit new GPs. DD certainly doesn't have a financial interest in any care homes, and I've never heard of this.

I know people don't like links, but this is worth reading to get a better picture:

www.pulsetoday.co.uk/your-practice/regulation/cqc/field-criticises-gps-for-charging-retainers-for-care-home-provision/1/20005921.article?PageNo=3&SortOrder=dateadded&PageSize=10#comments

It would appear that a few GPs are possibly abusing the system, which allows them to charge extra.

However, some of the problems are:

care homes are understaffed or, at least, don't have enough qualified nursing staff and call out GPs for problems they should be able to deal with themselves;

some residents are mobile, but care homes won't use their own staff to take them to a surgery;

care homes require a 'hospital' standard of paperwork from visiting GPs, which takes extra time;

some care homes are almost identical to the old geriatric wards and should have hospital staffing levels;

some CCGs don't put extra funding into care for people in residential homes.

I'm with Gaggi. If a GP has a number of care homes in his/her area (as some do), I'd be very miffed if the GP didn't have enough time to see all regular patients, because he/she was forever being called out to care homes. The extra funding to the GP should pay for extra surgery staff to cover for absences.

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.

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.

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.

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

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!

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.