ECFs and ANPs – The Future of Frailty?

Rachel Viggars is an Advanced Nurse Practitioner at Ashley Surgery (North Staffordshire CCG). Brigitte Knowles is a Elderly Care Facilitator at Madeley Surgery (North Staffordshire CCG). Both are undertaking the MSc Frailty and Integrated Care at Keele University.

We’ve always loved working with older people. Our roles in general practice certainly facilitate this!  When we were offered the opportunity to study at Masters Level in Medical Science: Frailty and Integrated Care, we jumped at the chance.  Finally, there was a focus on older people and an opportunity to improve standards and care.  But aside from this, it was a fantastic opportunity for us to complete a MSc in an area that we are passionate about, and the multi-professional learning that took place, really valued us as individual Health Care Professionals.  We were able to share and learn from the other professionals on the course and we really started to believe that we could do this and make a difference to our patient groups. 

It was initially a one-year course at Keele University incorporating modules on geriatric medicine, law and ethics and it focused on viewing frailty as a long-term condition. It was certainly an interesting first year – mixing predominantly with GPs and Specialist Doctors on this course we were apprehensive as to what we could achieve but we used our enthusiasm to fly the flag for the nursing and Elderly Care Facilitator (ECF) roles. Our confidence grew and we grabbed the opportunity to progress to the 2^nd year to complete a Post Graduate Diploma.  Now, following fantastic support from the Local Workforce Action Board, funding has been agreed to commence the final dissertation year.  This is really impacting on workforce diversification for the frail elderly population and will continue to do so across our locality.

In our local area significant progress is being made in the provision of care for patients who are living with frailty:

An Extensivist Service is being piloted. Older patients, including those with frailty, who are at high risk of admission, are seen and managed by a multidisciplinary team (including a GP, therapist, CPN, etc.).  This is all in one hub, thus hoping to reduce the burden on the acute service.

The ECF role began as an Over 75 Project run from 2013 to 2015 at Madeley Practice in Staffordshire.  The purpose of the project was for all patients over 85-years old, patients with dementia (at any age) and housebound patients (at any age) to get a full holistic assessment.  This incorporated functional, social and medical problems.  It was a successful project and has therefore been rolled out throughout Newcastle-under-Lyme from April 2018.  Now each Practice in Newcastle-under-Lyme has an ECF in place to deliver this service for their own patients.  The ECF role is not a medical role but focuses on the things that the doctor may not have time to do in their ten-minute consultations (e.g. social isolation).

At Ashley Surgery the Senior-Plus Service incorporates the ECF project, we work with AGE UK to provide a social assessment including benefits check and support, and in addition to this we have an ECF. An Advance Nurse Practitioner (ANP) service has been developed for housebound patients where we visit for all of their annual reviews of long-term conditions (LTCs), frailty assessments and risk stratification.  Also, appropriate home visits as requested by frail patients, where the GP would have usually visited, are also done by the ANP.  This has a significant impact on our older patients living with frailty as it provides a more holistic assessment.  This enables rational prescribing and better control of LTCs.  It has been noted to subsequently have a direct impact on quality of life for these patients and reduce demand on GP home visit requests.

The MSc pathway has enabled real progression and knowledge development to develop these services for the benefits of patients but also primary care services as a whole.  Going into our 3^rd and final year the dissertations give us the opportunity to evaluate this service and hopefully embed the ECF role as a permanent member of the general practice team.

The imminent Frailty Core Competency Framework (due to be published in May 2018) will enable identification of educational needs for patients and their carers, and address potential solutions (including the use of digital technology).

Role diversification is vital and needs to be encouraged.  Think you can’t do something? You probably can, be brave, think outside the box and seize the opportunities to lead the way. Exciting times ahead! Watch this space!