The Carer In The Cotswolds and Friends report on the local NHS’s response (four months delayed) that there need not be any contractual actions taken, in the wake of my mother’s death, in July 2021, in respect of its private partners in Gloucestershire, the ‘Practice Plus Group’. This is the independent organisation receiving, I believe, tax payer funding to provide the NHS with ‘Out-Of-Hours’ Visiting GP services across the county, and which continuation it is the responsibility of the ‘NHS Gloucestershire Integrated Care Board’ to sanction.

The latter is the designation (introduced this summer, supposedly to make its function more transparent to the public!) of the body in essence overseeing the running of the NHS from day to day here. Its forerunner was the Clinical Commissioning Group. Basically: are the NHS services funded with your money up to scratch?

Who is it that has told the ICB (above) that the Practice Plus Group’s NHS contract is not to be changed (or even ended – though pigs would sooner fly)?

Why, the potentially, I would assume, financially disadvantaged Practice Plus Group itself!!

The Practice Plus Group decreed the conduct and standard of care referenced below warranted no action of any kind – and the ICB has therefore announced it is to make no comment of its own.

Below you will find my response to the CEO of the NHS Gloucestershire Integrated Care Board

********************************************************************************

Dear Chief Executive,

Thank you for your response of 26th September 2022, in which you (finally) indicated the NHS Gloucestershire Integrated Care Board is not prepared to pass its own comment on the unacceptable standard of care received by my mother during a home visit, in the early hours of July 12 2021. She died, amid an increasing state of pain and distress, and sense of abandonment, mid-visit, having already been forced to wait 12 hours for a doctor to arrive from ‘Out-Of-Hours’ (the ‘Practice Plus Group’) – it having taken no contingency arrangements to arrange for GP Visiting Car cover in the event of withdrawals due to illness, on what it must have known would be the busiest night of the year (in the wake of the Euros Final the previous day). The night time Visiting Service was thus reduced to one doctor for the entire county, from 11 p.m. the previous evening onwards.

I sincerely hope that, should you yourself, or any of your colleagues on the Board, ever reach the age of 89, but find yourself bed bound (and therefore reliant on a visit), and suffering from delirium, that you (and yours, subsequent to your heart breaking demise) will be satisfied (as has professed itself the Practice Plus Group) with a visit where:

– The GP – mid-visit – withdraws from your supervision (for 50 minutes) both members of a two man crew you yourself have helped to fund to attend, precisely so that at no point should you be left without medical oversight, from one or the other, until its (safe) conclusion

– No evidence – or even acknowledgement of the request, in the case of the Practice Plus Group – is given you of any medical commitments whatsoever the GP claims s/he has had to withdraw to her/his car outside to perform, in private (redacted, but timed, emails, and/or phone logs)

– The GP does not seem to have the gumption, ringing an ambulance call-out line identified as lower priority than 999 since its inception four years earlier, in the National Ambulance Service guidelines for its usage (the latter further indicating s/he was all the more expected to do so anyway in the case of my mother’s condition – acute abdominal pain – and additionally suggesting this was a type not to be left unsupervised at all), to switch (as is surely reasonable to expect) – once – to the 999 service, when the aforesaid HCP (Healthcare Professionals’ Line) does not pick up in 90 minutes

– S/he thereby, single-handedly, delays, by anything, we might expect, between 60 and 90 minutes, the entire Out-Of-Hours GP Visiting Service county wide (no other doctor on duty); leaving other patients, as well as you, at risk, and in pain and distress; but still picks up a wage, from the tax payer, for the provision of so called urgent care that night (for which category of work such inertia and inflexibility would clearly mark him/her down, again to any reasonably minded person, as grievously unsuited). Her/his employers, the Practice Plus Group, NHS (private) partners, seeming furthermore to find nothing wrong with this dangerous and distasteful state of affairs; ditto, judging from its disinclination to pass its own comment, the actual NHS (in the form of Practice Plus Group’s NHS overseer, the NHS Integrated Care Board)

– From nowhere, by comparison with all your own experience of health care down many years, and for no currently watertight reason you can see (but with generalised approbation, I am careful to report here, of all authorities – although the South-Western Ambulance Service Trust has now committed to an additional response regarding an aspect of their own (earlier) visit I believe to abut on to this), s/he chooses (despite your several counter recommendations at the time), as her/his patient’s painkiller, a type of medicine – injected morphine – that you, in hindsight, now (even) further believe unsuited; not only, at the level applied, to their obviously frail physical condition and age (one that, to your mind, represented, rather, the top of the range dose for any elderly person – for someone, say (unlike them), in good general health, and up to twenty-five years their junior – with all the ‘uncertainty’ that carried); but also to their actual medical circumstances on the night

– The GP has omitted to check the charge on his/her defibrillator before setting out, and it cannot function properly from an early stage of CPR

– The reprehensible and, to you (especially in hindsight), distressing, even offensive, torpor (add your own choice of noun) with which, you cannot but conclude, the GP is by this stage addressing matters is apparent when your son, who has had enough, and takes 999 out on his own phone to force him / her on to them, instead, ”’allegedly”’ discovers her / him, after a 50 minute absence during an ongoing visit, with no checks at all on your condition indoors, flat out, eyes shut, deep down in her / his vehicle (as one and the same line continues endlessly to ring out, unanswered).  All public spirited reports of the circumstances of which failure to reinstate oversight (with no other work in progress (lol)), from a meaningless pleb such as he, a mere  member of the public, ‘The System’ is, of course, built to reject at source. And this just at the point when, unbeknown to that son, even back sitting at the bedside, you die.. without a doctor.

– Where…

I could go on, but what’s the point? The stance of the ICB is clearly the same as
others’: ‘See No Evil, Hear No Evil, Speak No Evil’

End of my response.
*****************************************************************************

When aspects of my mother’s sorry end to a proud life were published in the Press, the first commentator added: ‘Nothing will be done about this. This is the type of behaviour we the public find disgusting, but the NHS and GMC find acceptable’.

How right he was.

On this site, you might in fact like to check out the poem ‘See No Evil, Hear No Evil, Speak No Evil : NHS Style’. Also, the separate report of the physical injuries my mother had sustained in hospital care here earlier, in April 2021, for which, I have been told, no explanatory documentation exists (not for the first time with this Trust, down the years). Gloucestershire Hospitals NHS Foundation Trust has accordingly been reported to the Care Quality Commission, for, to my mind, and the CQC’s initial reaction, inadequate record keeping.

Further afield, I see no harm (and great advantage to you) in linking my mother’s own story with an article that appeared on Gloucestershire Live in April 2022, and stretched back to inspection in November (2021), when Practice Plus Group’s entire out of hours service received the most dreadful ratings from the Care Quality Commission:

‘Neither safe, effective, responsive, nor well-led’. The latter (its national level leadership) the very people who have now rubber stamped the conduct and standard of my mother’s visit as acceptable.

Go to

https://www.gloucestershirelive.co.uk/news/gloucester-news/gloucestershires-out-hours-gp-service-6902367

And now – for a second successive year, and thereby extending across three (2021, 2022 and 2023) – the self same damning assessment has been delivered once more on this service. Plus a warning the PPG is not even meeting its legal requirements – never mind its contractual commitments. 

Go to

https://www.gloucestershirelive.co.uk/news/celebs-tv/gloucestershiresout-hours-gp-service-rapped-8159374

I myself have further discovered, under Freedom of Information, at appeal (NHS Gloucestershire’s Integrated Care Board replied at first they did not hold this information) that the night time visiting GP service in particular has, without intervention, been allowed to operate at half strength 35% of the time – over two whole years!

Could you make this up? Fortunately for the CEO at NHS Gloucestershire, it’s not people like her who suffer as a result – but ones like my poor mother. Who deserved much, much better than this.