An article by Daphne Havercroft. In 2015 Daphne retired from a career as a senior project and service delivery manager for a global IT services corporation. She has seen and experienced the very best of NHS care, delivered by skilled and caring health professionals, and also the worst of the NHS, particularly its leaders’ callous attitude towards the elderly, which has been exposed for all to see during Covid-19. Her Twitter account is @DaphneHavercro1, and her blog can be found here.
Earlier this year a study was conducted to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital, and to investigate the association of frailty with mortality and duration of hospital stay. The report was published on 30th June.
The researchers concluded that assessment of frailty is crucial to inform clinical decisions about COVID-19 treatment and urged its use as a key indicator to assess a patient’s risk of dying.
It is not surprising that frail patients are at higher risk of dying of Covid-19 and it follows that assessment of frailty is also likely to be crucial to assess a patient’s risk of dying of other potentially serious illness, such as ‘flu.
One of the researchers commented that if people believe that they fall into the high frailty category they should ask their GP for an assessment. This is a tall order when many GP practices have used the excuse of Covid-19 to close their surgery doors to patients and deny them face to face consultations.
GPs have never been employed by the NHS. They are contracted by the NHS to provide defined services. One of the services is to proactively identify patients with moderate to severe frailty. Covid-19 does not release GPs from that contractual obligation.
Pages 33 and 34 are informative. The Contractor (GP) is required to take the following action, not wait for patients to prod them into action:
- Annually identify any registered patient aged over 65 living with moderate to severe frailty by using the Electronic Frailty Index (EFI) or equivalent.
After wading through online NHS documents I eventually found this NHS England list of indicators of frailty:
For patients assessed to be severely frail, the GP is contractually required to:
- Undertake a clinical review to include an annual medication review and history of any falls.
- Provide the patient with other clinically appropriate interventions; an example is physiotherapy.
- Instigate a discussion with the patient about an enriched summary care record, described here with two examples which record the patients’ wishes about resuscitation.
It has been alleged that NHS managers responded to Covid-19 by telling care homes to put blanket ‘do not resuscitate’ orders on all residents. Every care home resident should be registered with a GP. On admission to the care home every resident’s GP should have discussed and recorded their wishes about resuscitation as part of a documented care plan. The resident and their family should have been be fully consulted on the care plan. Therefore there should be no circumstances, not even a pandemic, where an NHS manager is allowed to impose a blanket ‘do not resuscitate’ policy on care home residents.
I have never met anyone aged 65 and over with obvious frailty who has been formally assessed by their GP. If this lack of compliance with the GP contract is widespread, and it seems to me that it is, it means that the NHS is not performance managing its contract with GPs, thereby allowing them to avoid providing the primary care services that they are paid public money to deliver. The risk this poses to patients is avoidable deterioration in health which makes them more susceptible to unplanned hospital admissions and poor outcomes, including death.
The Department of Health and Social Care has recently produced more Covid-19 propaganda:
Some people may think that they are protecting Grandma by wearing a face covering, not hugging her and clapping like a chimp for the NHS. Good luck with that.
I suggest that a much more effective way of protecting Grandma (and Grandpa too), is to help her to make sure that her GP provides her with the primary health care services that she is entitled to receive and which the taxpayer pays for.
If her family doesn’t have the courage to do that for her, they can be sure that the Covid-19 obsessed NHS won’t either.
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Update 2: Note that the NHS poster above is real. There has been some discussion on social media about whether it’s fake, but you can confirm it’s real by going to the ‘Uk government’ Facebook page.