Friday 20 January 2012

Rock and a Hard Place.......

"74 year old male, DIB, Lung cancer patient"

Every day, there is constant battle between ambulance staff and elderly people. This stems from their need for hospital, our wish to take them and their refusal to go. Sometimes we win, sometimes we loose and visa versa. On the occasions where we loose and they win, invariably we try to refer them on to a GP or another appropriate care pathway so their condition can be assessed / monitored / treated at home. Sometimes this less disruptive option is the most suitable for both parties anyway but sometimes it's the last resort and merely an arse covering exercise. Getting a GP to call is easy, getting a GP to visit.........not so much!

We arrived an Lenny's house mid morning. We were met by the housing warden, who had called us, at the front door. She explained that he didn't trust the NHS as a whole, he hated doctors, despised hospitals, disliked nurses and isn't too keen on ambulances. He had recently been diagnosed with lung cancer but refused to kick his 40 a day habit or take medication. She was concerned he was having breathing problems. I went in with my biggest smile and was met by his biggest scowl. After about 20 seconds I won the battle of wills. I got a smirk out of him. He was a lovely guy. A true cockney, speaking in rhyming slang where he could and was most impressed I replied in kind! The crux of the matter was, he had a chest infection. He had a slight temperature, fast heart rate and a productive cough. He made it perfectly clear, under no circumstances whatsoever was he going to hospital and to be perfectly honest, a GP visit would suffice. I took his GP details from the warden and noticed his GP wasn't anywhere near where he lived. It turns out he had only moved to the area 3 months ago and had been struggling to get registered with the local GP. Let the fun begin......

I called his GP and unsurprisingly they were not interested in travelling the 9 miles to see him. Right, the local GP it is. Apparently, the reason he wasn't registered was that the surgery has a rather archaic system where by the patient has to go to the surgery for a consultation to get registered. As Lenny's mobility was poor and he had no means of transport they were not willing to register him. Surely not. After waiting 8 minutes for a receptionist to answer, I explained who I was and who I was acting on behalf of. She suggested the patient make his way to a walk-in centre. I said he can't walk. She told me he would have to come for a consultation next week. I said he wasn't able to get there. He was elderly and immobile. She said he'll have to make do without a GP. Brilliant! I offered to come and get the registration forms, get them filled out and bring them back. She refused. He has to come in person. I asked to speak to a GP as I wanted one to come and visit him, and while they were here, register him. She refused. I asked for he name. She put me through to the GP. I regaled my whole story AGAIN and was told in broken english he would have to be a registered patient if he wanted a home visit. 

"How is he supposed to register then?"

"He'll have to come here"

"But he can't walk"

"Well he can't register here then"

"Surely, you have procedures in place for immobile elderly patients"

"No, this has never happened before"

"Well what do you suggest, he is ill, he has an infection, his GP won't come, you won't come or register him and your receptionist won't let me come and register him. He is entitled to treatment"

"Well why don't you take him to hospital"

Silly me, why didn't I think of that. Such a simple solution. That's why they are GPs and I'm an 'ambulance driver'. That degree in medicine really does scream true. Prat! Without swearing I explained AGAIN that he was refusing hospital and had capacity to do so. A GP was my only option short of leaving him at home to become septic.

"Well I'll write a prescription of Penicillin for him to pick up, when he's better he can come and register"

"Firstly he's allergic to Penicillin, secondly he's immobile and his osteoporosis and arthritis are not going to get better"

"OK, I'll write a prescription for Amoxicillin and you can pick it up"

"But you haven't seen him, you don't know his observations and won't he also be allergic to Amoxicillin?" (Worrying!)

"I meant Erythromycin, I don't need to see him, they should work"

"Fine, that's your call, not mine but how does he register"

"He'll have to make an appointment and come in"

Aaaaaahhhhhh! I admitted defeat! I couldn't go through it again. I'd got him some medication and hopefully that did its thing. We left Lenny to his busy schedule of chain smoking and NHS hating and to be fair, I see his point. It took me a 27 minute phone conversation to get him nowhere nearer to having a GP. I filled out a vulnerable adult form with my concerns so what will happen I don't know. He appears to be stuck between a rock a hard place, and with no one willing to shout for him I fear he'll just fade away quietly. How can a man who paid tax and national insurance for 50 years not be entitled to a GP because of his inability to physically go to the surgery? Madness! And the government want to put the GP consortium in charge of the NHS? God help us all!


  1. Maddening the system is sadly utter shite!


  2. Ahhh these are the worst calls, GP's are useless well done for managing what you did!

  3. @princesschar896 July 2012 at 09:17

    This mader frustrated just reading it! How can some gps be so uncaring and lack a great amount of common sense!
    Our gps are as a whole pretty good if we call up for advice/visits etc...
    This one seems like he's in the wrong profession....


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