Community Geriatrics

“Conference on community geriatrics. Plugging the huge gaps in knowledge of older people in primary care.”

 “Care/nursing home residents: Frequently an unseen and under-treated group, despite having some of the highest needs #olderpeople #nhs” 

“Systems to identify, assess, plan and treat at risk older people in care homes – huge difference to quality of life of most vulnerable.”

These were some of the Tweets published by Tom Gentry, Age UK, during our successful one day event on 15 June which aimed to share developments in community geriatrics.

Over 60 geriatricians, GPs, community matrons, occupational therapists, physiotherapists and others with an interest in caring for older people in community settings, met in Leeds in June to learn from eachother about what is working around the UK with regard to providing sustainable community care.  Expert speakers provided an overview of research and challenges relating to the provision of acceptable healthcare for care home residents and how to improve multidisciplinary working.

Eileen Burns, Chair of the BGS Community Geriatrics Special Interest Group (previously known as the Primary and Continuing Care SIG), welcomed delegates with a reminder about the importance of community geriatrics in view of national health and social care policy drivers encouraging an increased role for community services and a reduced dependency on acute hospital care.  Interactive sessions and group discussions provided an opportunity for networking and inspiring others and also a forum to air concerns, such as the lack of training and mentoring in community geriatrics.

There was debate about the very organisation of primary and secondary care and how to ensure that frail older patients are taken care of by a fully integrated health and social care system.  Delegates were asked to think about what they wanted to see commissioned by Clinical Commissioning Groups (CCGs) and to consider what would suit their locality.  Several speakers emphasized the importance of building relationships between geriatric services and GPs and maintaining good lines of communication.

Professor Steve Ilife provided a commissioner’s perspective on effective inter-professional working for frail older people and proposed the ideal model – the Chinese restaurant: spread virally to all areas, all different but all pretty much the same.  Dr Illife warned that all approaches to commissioners which present arguments or models based on “more” won’t work.  He said that commissioners need to see a 20% + change effect to want to take action and that getting involved in dialogue at a local level is essential.  The best way to enthuse GP commissioners is to relate issues to general practice – highlight a problem and present a solution which is evidence based and not predicated on needing more funding.

There are many examples of excellent models of care which are reducing hospital admission rates and increasing the number of people dying at home – both seen as measurements of good practice.  Case studies of what is working are available on the BGS website.

Issues raised during group discussions included: how to use virtual wards and their role as part of local risk stratification; how to manage increasing numbers of patients identified by risk stratification tools; how to secure financially sustainable services for dementia, end of life care and care homes; benefits of a rapid access mobile multidisciplinary clinic; role of interface geriatricians and advance nurse practitioners; efficacy of medication reviews and the status of intermediate care.

If you would like to join the SIG to keep in touch about any of the above issues, please contact Geraint Collingridge.  The intention is to hold another Community Geriatrics event in 2013 but in the meantime presentations from the day are available