legislation regarding home GP visits, any rights?

[worried33]

Ok so a long term problem I have about 2 weeks ago suddenly got much worse, since then it started to get better slowly very temporarily before exploding out of control.

 

My situation is this.

 

I am for the most part now limited to my bedroom, which has my computer, a tv and my bed. I have the kettle in here, coffe, sugar, bottled water, and some juice bottles. Some unused spoons, pot noodles basically I am living in the room for the most part.

 

The reason is this.

 

At its worst I couldn't stand up for more than 5 seconds or so at a time due to extreme discomfort, when standing up its with bent legs,m unable to even get close to been straight, mild back pain to go with it, and I had quite heavy pain even during sitting down. when trying to lie down not only couldn't I get my legs in a position where the pain would stop I started spasm'ing over my entire body uncontrolled movements. Ringing my GP yielded a result of "just wait 12 hours to next day and come on" as if they have no care in the world, yet at same time is not a 999 level of emergency? so was no 999.

 

I had a phone consultation with a GP, he has my history notes and I made it clear this is a long term issue I have but it suddenly has regressed, but he diagnosed a infection and prescribed me powerful painkillers. My sister picked those up and brought them to me.

 

Since taking those painkillers I don't get excessive pain in bed, spasms thankfully not came back, and sitting down isn't so bad (but still pain), I am however no more mobile, aside from the first 20 minutes ot so when I get up I can barely stand up, and cant straighten my legs. It gets worse as the day goes on. In particular I cannot do certain things due to the ebnding and leg movement required such as.

 

Take trousers on/off

Put on footwear

Sit down on toilet without extreme diffilculty. As its very low down, any low seat is hard to sit down and get up again.

Stand up for more than a few seconds, after that point am in excessive pain.

Cant straighten legs, motion of walking is very tough. I have had to do some walking to topup kettle go toilet etc.

Have had one shower, but as my shower is in bath, stepping into the bath I almost pulled my leg (it keeps feeling as if will tear).

Not been able to shave.

I think it would be extremely hard if not impossible for me to get myself to a vehicle and then get in the vehicle (which be low down), get out the vehicle, walk into GP or something, and then get back again.

 

NHS direct tell me to either get myself to a&e or contact GP.

GP tell me phone appointment or attend only no home appointments.

 

So how does the nhs treat people who need visual inspection but cannot leave the house?

 

There seems to be an assumption people are either life threatening or can get themselves to hospital/GP. An assumption is always someone to assist etc.

 

My sister who is my only family member near me with a car wont take me, so now I am at a standoff.

 

My sister was going to bring meals round but she abandoned that idea before she even came the first time.

 

In my view I need a wheelchair, and quite possibly will need to move as well so I can use said wheelchair in property as this place not suitable. I assume all this has to go via a GP.

[veganite]

hello,

i am not sure about the legislation regarding GP home visits.

 

This link: https://www.gov.uk/financial-help-disabled/home-and-housing shows details of how your local council can make direct payments to you if you find a carer to help with your day to day tasks.

It also shows you grants which can be used to make building work to your home - so you can move around and not be stuck in just the one room.

 

You say your current home is not suitable, so that is the reason I have placed the link above.

 

Hopefully someone can advise you regarding the GP visits.

[reallymadwoman]

Have you tried contacting your local PALS? They may be able to make some suggestions.

[worried33]

What is PALS?

[reallymadwoman]

Something like Patient Liaison Service - they're often based at your local hospital and are supposed to help with all aspects of the NHS, including GP problems. They should be in your phone book or perhaps your local hospital web site will have a contact number.

[worried33]

ok thank you, will look for them.

[worried33]

Someone will see me in my home next week, the receptionist was close to threatening me tho.

[nolegion]

Hang on in there, and congrats on getting them to come to you at last. Pls keep us posted.

[stevemLS]

There is no legislation obliging the doctor to do home visits.

 

However, in the GMS (General Medical Services) contract, which is the contract which governs all GPs in England (with very limited exceptions), clause 7.6 says that if a patient needs a home visit then the doctor will do that.

 

There is a bit of a get out in that this duty is only triggered if "in the reasonable opinion" of the doctor the patient needs a visit - however, from what you describe it would be unreasonable for the doctor not to reach that conclusion.

 

I know you have had a visit arranged, but thought this might be helpful for you and others in the future.

[nolegion]

That's useful to know.

[Sali]

Do you have a diagnosis for your condition? Surely that would be the first stage in getting treatment, on-going care and support.

 

I am confused how your GP can diagnose an infection without seeing you - and then prescribe painkillers?!

 

Quite frankly if I were having trouble getting a GP to do a home visit, I would wait until the evening and call the out-of-hours support line.

 

When I've contacted this service on behalf of relatives, a doctor has always attended.

 

(http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/out-of-hours-services.aspx)

 

If things got really bad, I would just call 999. At least then you would be properly assessed.

[worried33]

In my area the out of hours service has one doctor for an entire city, he is overwhelmed and cannot do home visits.

[Sali]

It is very unlikely that there is just one doctor in the whole city offering out-of-hours cover. Who told you that? Where in the country are you located?

 

Whilst you can submit a formal complaint, it doesn't get you out of your current predicament.

 

Agaiin, if things get desperate, call 999. They will attend and you will be taken to hospital for assessment.

[worried33]

Numerous people have told me that, the area has severe issues. We have numerous GP surgeries staffed entirely by locums.

 

Anyway an update.

 

After going through some extreme discomfort I made myself get to see a GP at my surgery, she said all sorts of things could be wrong and I have the legs of an 80 year old (I am in my 30s). Given I couldn't undress myself, not maintaining hygiene etc. I was admitted to hospital supposedbly to have lots of tests.

 

I had a raised D Dimer in my legs, was given a blood thinning injection which made an improvement, but when I got moved upstairs to the ward, they decided not to persue the blood clot diagnosis, there was no test done to cancel out the earlier test, they simply decided to not persue it, they were evasive when I tried to find out why. After I got moved upstairs the only test I had done was a blood pressure test, nothing else, a very brief examination was done by a trainee doctor, and a senior doctor came later to discharge me, he didn't examine me but I assume relied on the trainee's work. Refered to neurology as an outpatient. A 2nd blood test which was promised to rule out muscle inflammation never occurred.

 

Currently considering what to do against the hospital as its twice now I got sent home whilst in a bad state to fend for myself and without a diagnosis, seems very silly to not check for everything when they do a blood test, there should be no reason to do 2 blood tests close to each other, unless corners are been cut. They day after I got discharged I had a noticeable improvement, which I have put down to the blood thinning injection.

 

I asked the GP how long this injection lasts for, she got evasive and wouldn't give me an answer only stating I cannot persue the blood clot diagnosis so her attitude changed as if she doesn't want to go against that consultant. I asked her given I had other symptons such as swelling legs and feet, how did they rule out blood clot as a cause of that, again no answer.

 

I asked what scans are available to check the condition of muscle and tissues on legs, answer was nothing, apparently no such scan exists, yet my mother had one last year on her legs, all very bizzare.

 

Told the GP I been out of work and on benefits for 10 years with this problem, and in all that time I have had one single ultrasound scan on my right leg, which is a bit silly. Also was silly doctors in hospital asking me what I been doing for 8 years accusing me of reporting the problem late, they then all went a bit quiet on the subject after they found out I had been reporting it to GPs.

 

So after admitting the situation is a farce the GP has referred me to another guy in another hospital,, she said "he is good at solving unusual problems", other then that I got no idea who this guy might be. I also have to go in to my GP surgery for another blood test, no idea what they checking for, given I had one last Friday in the hospital. The NHS loves doing blood tests, but it seems not much else, I guess because blood tests are cheap.

 

One of my sister's has agreed to attend all appointments with me now, as she thinks I am been trodden on.

 

The improvement I had on Saturday indications are its temporary, I have been regressing since. My sister also has experience of working in old people's home's, she said my legs look the same as people she had to deal with who had confirmed blood clots and will be mentioning this and asking for medical proof to prove its not a blood clot. So far the only weak explanation I have had is apparently it cant happen in both legs.

 

The reason my sister is getting involved now is I am not far off needing to live with someone else so now all my family is panicking as I know none of them wont want to live with me.

[estellyn]

sorry to hear about the troubles you are having. I can certainly relate to the issues you have with doctors and the NHS - one hospital stay ended with me discharging myself (pretty stupidly, but I hadn't slept for days and had poor decision making at the time) and a lengthy complaint. The GP who admitted me, also had refused a home visit and insisted I attend the surgery - and saw for himself why I'd requested a home visit.

 

The best thing to do is to make a complaint to the practice manager - be polite but firm about your issues. Also make a complaint to the hospital - mine had an email address this could be done to which made things easier.

 

Regarding your accommodation - if it's not suitable then you need to contact the council to be rehoused. Your doctor may be contacted and you should have an OT assessment to assess your accommodation needs.

 

Regarding a wheelchair, you can be referred to OT via your GP surgery, or you can self refer I believe.

 

You should also get an assessment by adult care services - in my area you can self refer - you should be able to find out online.

 

I can't remember whether you've applied for DLA?

 

I really hope things get better for you.

[worried33]

Thanks estellyn as usual you stand out on here helping others with excellent advise, pretty much everything you have said here no one has told me about.

 

I did send off a DLA renewal form late but was half hearted as I don't have immediate financial need for the money, however I did it as DLA seems to be gateway to further help, but as things stand now with this now much worse condition I am struggling mobilising in my home which is a small ground floor flat.

 

Basically the hospital felt like a WCA, the sort of questions and a lot about me living on my own as if they making an assumption if someone is on their own it must be they not that bad. I am hesistant to complain about the GP she did admit me and is acting sympathetic when talking to me, but I guess the refusal to even try blood thinning drugs on me and bounce it back to the hospital is an indication she is holding back. Will do as you suggested anyway with the advise. are you able to tell me what OT stands for?

[estellyn]

OT = Occupational therapist

 

The hospital should be investigating your symptoms, not your home life - those are questions when planning discharge.

[worried33]

interesting thanks, so they were planning discharge very quickly after I went up to the ward then, that's pretty shocking.

[estellyn]

interesting thanks, so they were planning discharge very quickly after I went up to the ward then, that's pretty shocking.

 

what I've found is that a lot comes down to blood test results and obs - if initial tests and obs (observation such as blood pressure, pulse, temp) come back clear and they can't see anything that they feel needs inpatient treatment, then they send you home. I've been on the other side of that, sitting in an assessment area for hours and hours, waiting for test results to come back, feeling a bit better, wanting to go home, but then the bloods and obs say I'm too sick - it's frustrating because I'd been, on that visit, sitting with others being assessed who looked much worse, and were very unhappy when their tests came back showing nothing and they are sent home, despite feeling really ill and in pain. It seems unfair to me that so much emphasis is put on the tests, and much less to examining and listening to the patient. It's as if many doctors can't take on board or treat conditions that they can't 'see' with their tests.

[worried33]

Yeah so seems stubbornness or maybe red tape.

 

I think I am also have a reaction to the injection I had as it looks a mess getting worse daily which is not what I would expect, I guess people are supposed to be observed after for these things.

[estellyn]

Yeah so seems stubbornness or maybe red tape.

 

I think I am also have a reaction to the injection I had as it looks a mess getting worse daily which is not what I would expect, I guess people are supposed to be observed after for these things.

 

when you say looks a mess, are talking about the injection site? If red, sore, inflamed, hot (or breaks open into a wound) you could have an infection. Though rare, it does happen. A bruise is normal at the site, and after a blood thinning injection is likely to be bigger, though if the bruising continues to increase you should get a doctor's advice.

[worried33]

yes its growing.

 

since my health is getting worse particurly mobility again, pain etc. going to the GP surgery when I feel like it is not really that viable.

 

Right now its 15cm long.

[estellyn]

Phone your docs for advice with the name of the injection you were given if you can't attend, or call the 111 advice service for an assessment.

[zippygbr]

It is very unlikely that there is just one doctor in the whole city offering out-of-hours cover. Who told you that? Where in the country are you located?

 

Whilst you can submit a formal complaint, it doesn't get you out of your current predicament.

 

Agaiin, if things get desperate, call 999. They will attend and you will be taken to hospital for assessment.

 

that is entirely likely for OOH

 

1 doing visits, a couple doing phone consultations and a couple doing face to face in a UCC setting

[Sali]

Sorry to be slow, but what is a UCC setting?

 

I haven't had to call a doctor since 111 started. As I've said, the previous system worked in my town. There were numerous occasions where a doctor attended.

 

My view is that just as there should be a legal obligation on nurse to patient ratio in a hospital, there should be a similar requirement for doctors available for out of hours cover, providing home visits where necessary.

 

We are told on one hand that there are not enough GPs for the ever increasing population, but also that GPs are working less hours (partly due to the higher number of women working part-time), or alternatively raking in the cash working as locums in A&E. If we can determine the truth perhaps we can tackle the problem.