• Expert Q&A: Rare dementias - Tues 3 March, 3-4pm

    Our next expert Q&A will be on the topic of rare dementias. It will be hosted by Nikki and Seb from Rare Dementia Support. If you have any questions about rare dementias, they will be here to answer them on Tuesday 3 March between 3-4pm.

    You can either post your question >here< or email them to us at talkingpoint@alzheimers.org.uk and we'll be happy to ask them on your behalf.

What can be done to ensure care home residents get quality healthcare?

JPG1

Account Closed
Jul 16, 2008
3,396
"The task of delivering high-quality GP services to all the 421,000 residents of UK care homes, who are usually old and often have acute medical needs such as dementia, is a key challenge. But a recent name of newspaper deleted roundtable debate on the subject, in association with name of care provider deleted, one of the country's biggest care home providers, revealed that it is a challenge that is far from being met. The debate was held under the Chatham House rule, which allows comments to be reported without attribution to encourage a frank exchange of views."

"The roundtable agreed that the general medical services contracts between the NHS and GPs, which set out what services family doctors have to deliver, is nowhere near enough to ensure good care for residents. To get round that some care home owners pay GPs for "enhanced services" in order to ensure that a doctor will come when needed. Some can be reluctant and say it is too far to travel, the roundtable heard.

The name of care services regulator deleted found that 10% of owners made such payments. Other research has shown the sums involved range from £900 to £24,000 a year and average about £7,000. But these payments – called retainers – "are somewhat shrouded in mystery", the roundtable heard. Last year's name of society deleted report said such fees were potentially unlawful, as they could be seen as GPs being paid double for providing care that should be available free to all NHS patients on their list. One participant said: "We are breaking the rules of the NHS – people should have care that is free at the point of delivery."

One care home chain pays retainers averaging £10,700 to 38% of the practices that look after their patients. One participant even knew of some cases where GPs "ask for cheques to be made out to them personally". Interestingly, some panellists said that as far as they know paying these extra fees is no guarantee of better quality care."


http://www.guardian.co.uk/healthcare-network/2012/nov/28/care-home-residents-quality-healthcare

A report that may shock and surprise some people. Sadly, my own experience had already brought much of the content to my attention.

(The use of blue indicates where I have removed the names before posting.)
 

FifiMo

Registered User
Feb 10, 2010
4,710
Wiltshire
Very interesting article, both in terms of the acknowledgement of what is wrong at the moment and what should be able to happen in the future. As always, the standard get-out clause is there - lack of funding to implement changes that they would wish to.

As to the bit about retainers - I don't have a problem with retainers if it means that they will then provide a proper level of care. What is most annoying is when a Dr refuses to come out or you wait for hourssssssss for a locum to appear. Whilst they try to make retainers look bad, it is standard industry practice to use retainers to make people available as and when you need them. There is a cost to the GP practice in operating outside what they are required to provide - so why not?

Fiona
 

JPG1

Account Closed
Jul 16, 2008
3,396
I don't agree with you, FifiMo. :)

The retainer is no guarantee that the GP will provide even a basic level of care.

In my own case, the surgery from which the GP-receiving-the-retainer-fee operated (strange choice of word there!) was a fairly large 'almost health centre', with umpteen GPs. The contract with the care home, in my case, required the chief GP to visit once a week, to meet and greet and assess new residents, to check over new residents and their meds, to register those new patients and to prescribe accordingly thereafter; to attend to any 'routine' needs of the other residents registered with that surgery.

Sadly, the GP, in my case, didn't bother to visit the care home for 3 weeks; never logged his/her visits; never bothered to meet and greet new residents; refused to supply diabetes test-kits, and so on. Also, insisted on a form of communication between care home and surgery that was positively dangerous. So the residents were neglected. But s/he still was paid the retainer.

Fortunately, that same GP is no longer in receipt of a retainer for that care home and is no longer providing a 'service' to the residents of that care home. The dangerous method of communication between care home and surgery was also abandoned immediately.

It took the case of my own relative's neglect for that turnabout to happen.

If a GP accepts the responsibility for providing NHS care to his/her patients 'free at the point of delivery', s/he should not charge extra - and certainly shouldn't ask for the cheque to be made out in his/her name.

I cannot support the payment of retainers to a GP.

That is my own personal experience.
 
Last edited:

FifiMo

Registered User
Feb 10, 2010
4,710
Wiltshire
Hiy JPG,

I hear what you are saying. IF the retainers worked and got a good level of service then they might be worth paying. As I said though - that is not always the case. In our experience there is nothing more desperate than your relative being visibly in pain and the care home not being able to get a doctor to come out and being told that paracetemol would do fine until the morning. I bet none of their relatives would have been lying there in such pain and being chucked the odd paracetemol in order to pacify them - that's for sure.

Given the way that the UK has gone with regards to managing pain, I wonder whether we should all be making statements in our living wills to the effect that you have my approval to administer any pain killing medication in whatever dose in order to erradicate any pain!

Anyways, these reports when taken all together today just show what a sad state of affairs everything is in with regards to care. Totally depressing reading all round isn't it.

Keep up the good fight!

Fiona
 

beech mount

Registered User
Sep 1, 2008
1,524
Manchester
If a doctor has x number of people on the list then he/she is already being paid a retainer. I have not seen my doctor for over a year but i am on his list so he will be paid if he sees me or not. this would appear to be a form of "blackmail", pay me or i will not come,almost acceptable if they provided the best care they can, however this is not always the case.
And dont talk to me about dentists!
John.
 

FifiMo

Registered User
Feb 10, 2010
4,710
Wiltshire
Hiya John,

Like I said I don't have a problem with retainers in principle but not when you pay them and don't get what you've paid for. I don't know if the dr was on a retainer that looked after my mother's care home but he certainly wasn't minded to come out at short notice when we considered help was needed and fast. This might have contributed to our "no hospitalisation" notice having been ignored by an agency nurse that was on duty one night and found my mother to be non-responsive. So, despite the notice she ended up in hospital. Despite our reasons for having requested no hospitals, we ultimated found it to have been the best place for her. If someone said she should have X for her comfort and/or pain relief - it was administered there and then - not 5 hours later when a Dr who didn't even know her turned up.

Like you...don't get me started on dentists either ! LOL

Fiona