More about Mum...

As I battled through Friday I definitely felt a blog coming on!
I have written about my mum in the past. Yes, she is only one patient with her own story but so often it seems to me to reflect the bigger issues we face as we try to sort out the system and make it better.

On Friday morning my mother fell. Not a big fall but enough to worry the carers who do such a good job day to day and cope with her increasing confusion and distressing incontinence with sensitivity and kindness. They phoned her GP surgery. This is the surgery that tells you on the opening recorded message how busy they are. The same surgery where a receptionist told me a few weeks ago that the letter informing me of my mothers named GP didn't actually mean anything real and was just a "government initiative"

The duty doctor responded to the visit request. She has been in the practice less than a month. She clearly hadn't read my mothers notes: Did not know about her frequent falls, her previous admissions ( all unnecessary) her recent change in medication. more importantly she didn't have any idea about her usual level of confusion What did she do? She summoned an ambulance and sent her into hospital

My mother was no more unwell than she is every day There was no emergency. She tried to call me once, but I was in a meeting and had my phone on silent. By the time I phoned back it was too late. The NHS machine was already in motion. but why? Because she couldn't be bothered to find out more, and wait to see how the day unfolded. It was laziness justified by business. My mothers named doctor was in the practice that day. She has seen her once but because of my persistence and several phone calls could claim to know her. No discussion had taken place between her and the visiting doctor. Clearly the notes were either not detailed or clear enough or not read.

I brought my mother home from hospital on Saturday Of course they found nothing untoward. She was a bit disconcerted by her trip. If it hadn't been me she would still be there this morning because the system would have required assessments and planning to be done.

Primary care is at a cross roads Much is written about its future. It is in crisis. To survive it must clearly define what is its unique contribution to health care. What can it provide that no other part of the system can. Surely that has to be personal continuity of care for those who are most vulnerable and those with multiple complex illness.
What did my mothers gp offer her on Friday that a paramedic or A&E doctor who had never met her before could not have? Nothing. She was bundled into an ambulance in her nightie with no information about her or her problems. to a ward designed to deal with emergencies with staff who knew nothing about her. It was a frightening and completely unnecessary experience for her.

It cost the NHS upwards of a thousand pounds and resulted in no improvement in her care.

If this is all general practice has to offer it will simply become an irrelevance in the system, which will eventually decide it has no value and design something else to fill the void. As a profession GPs need to sort out their own story about their future, their relevance to a changed world and deal with the unacceptable variation in standards of care that mean examples like these are quoted all too readily to denigrate the service I have spent my life developing. It brings me no joy to tell this story today.

What needed to be different?
1. Good GP notes with a clear up to date summary
2. A practice system that flags vulnerable patients ( and if my mum who at 94 has profound dementia and had had 3 unnecessary urgent admissions in the last 18 months, isn't vulnerable who is?)
3. A receptionist on the visit request desk who sees the flag and directs the call to the patients named doctor or their GP buddy if they aren't in.
4. A named GP system that actually means something real, where that person is responsible for delivering on going holistic proactive care.
5. Either the named GP is able to visit that day or if that really isn't possible briefs the visiting gp and is available to discuss with them what they find at the visit BEFORE a decision about next steps is made.
6. Have a proper emergency plan for these patients proactively discussed with relatives in place etc. This could have prevented the alast 4 hospital admission
It is not rocket science is it? Would it be more resource intensive in the long run for the practice, for the system?? Not if it is properly organised

I have worked in primary care for 25 years. I am it biggest fan. Is is all as bad as this? No. but if it doesn't collectively get its act together and sort this stuff out it will not survive.

What will I do next? well I will send the practice my blog. I could complain but am concerned all I will get will be a list of platitudes and justifications rather than a commitment to really overhaul their system. I will think about changing practices but how do I know where to find something good? It isn't as easy as a nice looking building or a fancy website.

CCGs are co-commissioning primary care. Where do we start? Accountable care organisations might be the next step. To put it bluntly If the practice had to pay for that episode of care would they have made the same choices ? I doubt it. But primary care in a million miles way from seeing this future.

In the mean time my Mum is settled back at home until the next time.....