| -
RCGP/BGS Special Interest Group A
report on the Royal College of General Practitioners/BGS Special Interest Group
in Primary and Community Care joint seminar. Arranged
by Joe Neary, Chair of the Royal College of GPs Clinical Network, this training
day for GPs and hospital geriatricians was both informative and interactive. During
the first part of the meeting, the participants worked in small groups, defining
their priorities for delivery of care in the primary care sector. There was unanimous
agreement that there was need for considerable improvement and development in
this area. The most important issues were thought to be primary prevention, the
implementation of medication review, the care of older people with multiple pathology
and multiple disability, and the interface between old age psychiatry, geriatric
medicine and primary care in the care of older people with dementia. It was agreed
that partnerships between geriatricians and general practitioners need to be developed
to promote independence in old age, to provide effective care to older people
with chronic disease and/or frailty, and to older people in the care home sector. The
groups went on to discuss undergraduate and postgraduate training and the importance
of training medical students, both GP registrars and registrars in geriatric medicine,
as well as nurses, in the essential components of good care for older people.
Geriatricians were surprised to hear that until now some GPs had had little involvement
in the national debate on single assessment. All delegates agreed that the difficulties
in its implementation were compounded by the complexity of process. There was
agreement that assessment procedures need to be coherent, should take account
of all functional dimensions including special senses, and could be used as a
preventive tool. Standardise
single assessment process
Prof
Ian Philp, the Tsar, then provided a very eloquent response to the plenary session.
He agreed with some of the participants that there was a need for standardisation
of the single assessment process. Ideally, he said, older people with complex
and multiple needs required medical care from partnerships between general practitioners
and specialist teams in both older people’s physical and mental health. For
the care to be effective, all teams needed to have the appropriate skills and
competencies. There is therefore a need for an expansion of hospital specialists
and the development of general practitioners with a special interest (GPSIs) in
medical and psychiatric care of older people. Prof
Philp said that he regarded the key programme for the next few years, as workforce
development. Skills for health care will focus on vulnerable older people with
complex needs and will be addressing the learning needs of medical and social
care professionals. Having
agreed that the interface issues between Primary Care Trusts and acute trusts,
and between general community services and long term care facilities needed addressing,
Prof Philp proposed that the new GPSI would or could provide a resource to bridge
the boundaries. He was of the opinion that there was a need to train existing
GPs/GPSIs to develop a special interest in older people’s care. In answer
to the priorities outlined earlier by the participants, he was of the opinion
that locality collaboratives involving interested GPs, pharmacists and community
nurses should be set up. He emphasised the importance of user and carer involvement
in any planning and prioritising of services for older people.
Training
GPSIs - a priority Prof
Philp encourages the development of centres of excellence in order to train and
rotate through staff from all disciplines. But in order to address this complex
programme early priority will have to be the training and employment of 150 GP
specialists in the care of older people. This will require joint work between
the BGS, the Royal College of General Practitioners and specialist colleges. Prof
Philp said that the profession must take the lead in this exercise. In
the afternoon there were a series of out-standing presentations from Clare Royston,
an old age psychiatrist from Cambridge, Clive Bowman, Medical Director of BUPA
care homes, Professor Idris Williams, author of the recent Royal College of General
Practitioners’ occasional paper entitled, An evidence based approach to assessing
older people in primary care and Professor Chris Drinkwater, Professor of General
Practice from Newcastle. The participants then finished the workshop by setting
out their priorities for education, training and development to support quality
care of older people (see box). The
workshop provided a welcome forum for a constructive exchange of information between
GPs and geriatricians, and served to provide a number of important leads towards
enhancing joint working between hospital and the community care of older people.
All that we have to do now is make it happen - we shall overcome! | PRIORITIES
FOR EDUCATION,TRAINING AND DEVELOPMENT -
Improve the undergraduate experience and training in health care of older people.
-
Specialist training for GP registrars and newly qualified GPs.
-
Shared training for specialist and generalist registrars (GPs).
-
Four week orientation for GPs and consultants and possibly specialist registrars
new to an area (a little wishful thinking!)
-
General Practitioners as trainers for specialist registrars – exchange of
training.
-
Specialist qualification for nurses working in care homes.
-
Training for carers in care homes (the poorest qualified and the most neglected
on the carer spectrum).
-
Distance learning packs for the full range of professional roles.
-
Team training on a locality basis
-
Provision of more community geriatricians to involve all GPs at training level.
-
Coordination of services for individuals with complex needs and information on
services that are currently available.
-
A twenty four hour single point of axis.
|
Jackie
Morris
Chair: BGS SIG in Primary and Community Care
Joe Neary
Chair:
Royal College of General Practitioners
Clinical Network |