Transforming Primary Care – geriatricians will have a role to play

Dr Adam Gordon is a Consultant Geriatrician and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Honorary Secretary of the British Geriatrics Society and also edits this blog.

Today sees the UK Department of Health Launch Transforming Primary Care: Safe, proactive, personalised care for those who need it most. This is the artist formally known as the Vulnerable Older People’s Plan, which I’ve written about before . It was transiently called “No One Left Alone”, the transition from which is a bit a loss for tabloid headline writers.

The change of name, however, doesn’t change the fact that much that was of promise in the consultation documents for the Vulnerable Older People’s Plan, remains in the proposals outlined in the Transforming Primary Care document. There’s still considerable emphasis on continuity, effective communication and care co-ordination.

If implemented these may provide us with many of the levers needed in order to implement Comprehensive Geriatric Assessment (CGA) for all frail older people in a systematized way. CGA is the most evidence-based way to provide care for older people with frailty. It is multimodal, it assesses patients across multiple domains (medical, psychological, functional, social and environmental), it is multidisciplinary, it is iterative and it enshrines effective models of care and case management. It improves outcomes for older people with frailty – reducing the likelihood of physical deterioration, deterioration in mental health and of readmission to hospital.

CGA is specifically mentioned in the Transforming Primary Care document – three times in fact. It is slightly misused on each occasion – referring to an assessment document, or an initial assessment as a fixed event, rather than a process. The fact that it’s mentioned at all, though, is promising and important and the processes it is described as supporting – multidisciplinary, proactive, iterative and goal oriented – make up the rest of CGA, even though the DH document doesn’t describe them as being part of it.

Paul Knight said of the proposals that “the BGS are entirely supportive of the drive to provide to older patients, particularly those living with frailty, the continuity and integration of care that they value so highly. Geriatricians and their teams would wish to assist accountable GP’s in the provision of this care. We also believe a focus on the improving the skills of the health care workforce to deal with this frequently complex patient population is long overdue and welcome the opportunity to be involved in this educational drive towards excellence.”

The slight misapplication of the CGA terminology highlights the need for geriatricians to remain actively engaged. We know how to care for this cohort – we know what works and what does not. We won’t be able to deliver all the care ourselves but we will be able to help others do things in a way that is effective and achieves the best outcomes for patients and for services.

Much of the detail of how this will be delivered remains to be solidified. But whatever shape it takes, geriatricians and the BGS will have a role to play.