24.11.16
GPs and geriatricians urge greater collaboration to improve integrated care
GPs and geriatricians should work together as part of delivering improved integrated care for older people with frailty, the Royal College of GPs (RCGP) and British Geriatrics Society (BGS) have recommended in a new report.
The report’s authors said that collaboration between GPs and geriatricians should be “at the forefront” of care for older people with frailty, but had been held back because services were traditionally formed “in silos” at a national level.
However, the review highlighted best practice in 13 integrated care case studies from across the UK, ranging from schemes to help older people remain active and independent, to those providing better services in the community..
Professor Maureen Baker, chair of the RCGP, said: “Ageing and frailty are game changers for the health and social care services. GPs, in collaboration with geriatricians and other colleagues, are at the forefront of the response to these significant new challenges.
“This report outlines a number of exciting examples where College members have taken the initiative and put positive talk around integration of care into practice in order to improve patient care, their experience of the health services and health outcomes.”
Professor David Oliver, chair of the BGS, agreed: “General practitioners and geriatricians are expert generalists, respectively able to help co-ordinate care base on the needs of individual older people and their carers in their own homes or community healthcare settings and to oversee their care when presenting with or recovering from acute illness or injury in hospital settings and beyond.”
Longer life expectancy is contributing to the pressures on health and social care services because of the needs of an elderly population. A recent joint report from the King’s Fund and the Nuffield Trust found that in the past five years, emergency hospital admissions of older people have risen by 18%, compared to 12% for the general population, while GP visits have risen by 28% against an overall average of 15%.
The RCGP and BGS report said that patient involvement and choice should be central to older people’s care. For example, a GP-led service with daily access to a geriatrician was established in North Wiltshire. This allowed the patients’ wishes to be shared more easily.
Similarly, the report recommended a joined-up approach to ensure continuity of care across primary and secondary services. For instance, North West Surrey CCG established locality hubs, which are attached to community hospitals but operate in a network with GP services to help patients over the age of 75 with multiple long-term conditions.
GPs and geriatricians were also able to lead multidisciplinary teams involving health and social care staff. In Midlothian, this was successfully used to provide a team which would care for patients in their homes where previously they would have been admitted to acute services.
Delayed transfers of care, which particularly affect older people where social care is not available when they are discharged from hospital, are at a record high.
Other key recommendations from the RCGP and BGS report included strong communication links between GPs and geriatricians, developing links with community resources such as charities and religious organisations, and use of new technology such as video links.
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