Find out how to get the most from your GP and NHS here…
How your GP can help you and your elder
The gateway to older adult social care help varies across the UK from local authority to local authority (LA). But the GP is the gateway to the national health services, whatever your LA.
It’s likely your elder will welcome or need you to join them at GP appointments, especially if your elder can’t travel to the surgery easily. They may need help arranging GP appointments too. Try booking double appointments (20mins) if there’s a complex topic to discuss.
Explain your relationship with the elder to the GP (take the Lasting Power of Attorney (health) with you if you have one). Help share your elder’s health status, concerns, current or future treatment.
At the GP surgery, ask about:
- Current health issues, meds or treatment and whether a review is due. All adults over 40yrs are entitled to an annual health check at their GP surgery.
- Recent blood tests and what they reveal. Consider arranging a blood test if there hasn’t been one recently. There are treatable vitamin or mineral deficiencies that can impact older people, eg B12, D, Iron.
- Repeat prescription re-ordering services (phone or online). Can a home delivery be set up to make things easier?
- Dosage and its timing. It’s important that prescribed drugs are taken consistently, at the right time, every day to be effective. Some medicines with strong side effects are better taken at bedtime. Discuss this with the GP and choose medicine dispensers and/or reminders to help.
- Access to free continence support.
- Access to older adult social care help (occupational therapist assessment, care at home, or moving to a care home) if this is likely to be needed in the short term. While GPs aren’t responsible for social care, they’re likely to have useful local knowledge. There are signs of increasing collaboration, too (yay).
If you’re already concerned about your elder’s health or behaviour, arrange to take a urine sample to the GP on the elder’s behalf as it’s likely you will be asked for one. It’ll save a return trip. You can take the sample in any clean, labelled, sealed vessel and pick up a couple of sample pots when you’re at the GP’s for next time. Urinary Tract Infections (UTIs) are an extremely common cause of a wide range of distressing symptoms for older people. The symptoms can even mimic severe dementia. See ‘hydration in a heatwave’ for more on the importance of hydration and the extra care needed in high temperatures.
And let your own GP practice know that you’re a carer. GP surgeries hold a carers register and are increasingly organised to support carers better. Some are more advanced than others. At the very least you’ll be eligible and prioritised for free jabs to help keep you on your feet.
Marj and I shared a GP which was helpful in many ways, but somewhat unusual nowadays with families tending to be scattered geographically. If you do live close by or with your elder, consider using the same GP. When our GP popped out to see Marj at our home, they also gave me a quick consultation (kind and time-saving).
Here’s a naughty but handy tip, don’t let on I told you. One winter, years ago when Marj and other family members were constantly getting really sick (beyond usual viruses), I booked fortnightly GP appointments in advance. Whoever needed the appointment went to it, which did surprise the GP a couple of times. The GP kindly agreed to continue with the consultation anyway. Of course, if no one needed the appointment, I cancelled it early to free up GP time. This is a last resort, only for desperate circumstances and it may not be possible nowadays.
It’s a really good idea to keep your GP and their team ‘on side’, you never know when you’ll need a favour. I’d advise nurturing a good relationship, being reasonable and never taking the mick.
Support from NHS continuing healthcare
When an elder (or anyone) needs care and support for a healthcare need, the theory is that this is paid for by the NHS. This is because healthcare is free at ‘point of delivery’ in the UK (in theory).
If your elder has a critical medical condition like a stroke and can’t manage without high-dependency nursing care, the burden of care moves from Social Services to the NHS. If your elder qualifies for NHS ‘continuing healthcare’ (CHC) then their care is fully paid for by the NHS. This means that, unlike social care support, there is no means-testing. Assets and income are not taken into account nor are they used to fund the care received.
This ‘free care’ is a very attractive, often necessary option for families.
In theory, an older adult can receive NHS continuing healthcare in any setting (in their own home or a care home). While CHC is free of charge, the application isn’t straightforward and it’s very hard to get. The patient or whoever holds power of attorney needs to consent, the elder must pass through a national screening continuing care checklist and a full eligibility assessment. A health professional tends to carry out the eligibility assessment using ‘the Decision Support Tool’. From my experience it takes a long time for the steps to take place, so start your application earlier than later.
At the CHC screening (done at-home in Marj’s case), the assessor aims to confirm whether care needs are primarily due to poor health, measured in terms of its:
- nature [the type of condition or treatment required (quality and quantity)].
- complexity (symptoms that interact, hard to manage/control)
- intensity (one or more health needs, so severe they require regular intervention)
- unpredictability (unexpected changes in condition that are difficult to manage and present a risk to self or others).
So, for example, help with washing and dressing is a social need not a healthcare need. Another way of thinking about it is that it’s not about the medical diagnosis itself but about the manageability of the condition. Funding is not automatically granted if you have been diagnosed with a particular condition like dementia. Importantly, this is not a permanent ‘benefit’ to be relied upon and can be withdrawn at any time after a regular reassessment. This has drawn criticism.
Nevertheless, please don’t be put off.
If you think your elder may be eligible (many who are eligible may be missing out), your first step is to discuss CHC with the GP. Funding is scarce and local health authorities are overwhelmed by demand. As always, be tenacious.
In an excerpt from The Sunday Times 25/3/18, the NHS came in for criticism about not raising the profile of CHC and the complexity involved in applying for it. CHC is also inconsistent in its assessment across different LAs and can pit health professionals, LAs and families against each other. Here’s the article snippet…
Mental health support eg for dementia
Thankfully stigma around mental health is being slowly chipped away. Please ask for help if an elder’s behaviours are changing, they should be supported by their local mental health team. Responsibility for chronic brain diseases like dementia is held by older adult mental health services (not by the older adult social care service).
You can’t self-refer all mental health support, you may need to be referred by your GP. The Oxford Health Foundation Trust (OHFT) manages the Community Mental Health Team across both Oxon and Bucks. Here’s detail from Bucks Council. After a GP referral, your elder may be assigned a care coordinator.
Your elder may be referred to a ‘memory clinic’ from where chronic brain diseases are diagnosed and managed, at least initially. Marj went to the memory clinic at Stoke Mandeville. This is what the OHFT says about their memory service. Expect your elder to undergo verbal and written tests. This is worrisome, so do go with them for support and reassurance as some testers’ skills and sensitivity could be improved.
A CT scan may or may not be offered. Ask about the likely impact of any prescribed drugs, their side effects and discuss these before taking them. If the side effects are distressing (we’re all affected differently by drugs) then ask about alternatives. Your elder is then usually discharged back into the care of the GP until their condition becomes unmanageable, if at all.
In Bucks, an elder can self-refer to bucks talking therapies which offers free cognitive behavioural therapy (CBT) and counselling services, helpful for many people. Do consider.
Bucks Mind provides older adult counselling services too.
And lastly, be open-minded about antidepressants which can be beneficial for many older people.
Your advocacy
Whatever health support your elder needs, you’ll be increasingly needed to advocate on their behalf. When it comes to keeping your elder well, your opinion is as important as any health professional and should be taken into consideration.
Our elders sometimes show over deference to health professionals, especially those in authority, and may not speak up. Take the time to understand any worries before a medical consultation, even if it’s in the car on the way there. Your advocacy is even more critical during hospital admission.
If you live far from the elder you care for, google for organisations that can provide local advocacy. Bucks Carers have carer support in some Bucks hospitals to support you.
Keep well.
Love,
PS. Always seek your GP’s advice on healthcare matters first.
