Autumn Speakers Series: “Interface medicine”

Eva Kalmus has been working as Interface Medicine GP at Epsom and St Helier NHS Trust since February 2015 and previously looked after inpatient beds at New Epsom and Ewell Community Hospital. She was also a community ward GP in Wandsworth and virtual ward lead in Epsom. Currently her work is focussed on discharging patients for whom the acute hospital no longer offers net benefit as quickly and efficiently as possible and improving communication, aiming for primary, community and social services to pick up where secondary care stops. She will be speaking at the upcoming BGS Autumn Meeting in London.

“Interface medicine” has a number of definitions in different contexts—it seemed an appropriate title to describe primary care-trained doctors working in community or hospital settings whose aim is to maximise quality of life for older frail patients using skills and knowledge from both general practice and geriatric medicine.

On one side are Interface Medicine GPs now titled GeriGPs within BGS; on the other are Community Geriatricians but there is significant overlap in what we do. Working together we can best support our patients—and it is a very satisfying extension to our core business.

Are we really representing the BGS? Experiences from the Programme Board and a call for your contributions

Shelagh O’Riordan is a Consultant Community Geriatrician and Clinical Director for Frailty Services with Kent Community NHS Trust and tweets @jupiterhouse1 Asan Akpan is a consultant Geriatrician at Aintree University Hospital NHS FT and tweets @asanakpan

In September 2017, the BGS put a call out to its members for Geriatricians with an interest in care homes and Community Geriatrics to represent the BGS at the newly established Hospital to Home Programme Board, an NHS England oversight group and part of the Urgent and Emergency Care (UEC) Transformation Delivery  Programme.

Shelagh had just come to the end of a role at the Royal College of Physicians and, after 14 years, swapped her hospital role for a community one. Asan moved to a different hospital over 4 years ago to do mostly community geriatric medicine and has contributed to developing the service described on page 26 of the joint report on integrated care for frail older people by the BGS and RCGP.

The right intervention, at the right time, in the right place…

Stephanie Robinson is an occupational therapist at Harrogate hospital working as the  frailty team leader across the medical elderly wards and previously seconded into the Supported Discharge Service. She has had a key role in cross boundary working, outreaching from frail elderly inpatient based wards to the community.

The right intervention, at the right time, in the right place… How Harrogate District Foundation Trust therapists from the community and in-patient wards are tackling the national bed crisis: piloting a Supported Discharge Service.

The pressure is on in Harrogate – the population of over 60s is 26.5% compared to 22.4% nationally.  By 2030 the district’s over 65 population is predicted to increase by 15,000 people.  One of the Trust’s strategic aims for the next five years is to integrate acute, community and social care to allow patients to be treated closer to home, or at home and reduce reliance on acute beds.  It is understood that therapy assessments completed in a patient’s own home are a more accurate reflection of their capabilities than those completed in the hospital environment.  Based on the Discharge to Assess model, the concept that the hospital is often not the most appropriate place for patients of any age to remain is not a new one.

‘Water, water everywhere’; dehydration in the older population

Janet Gordon & Marie Henson both work for Birmingham Community Healthcare NHS Foundation Trust. Janet Gordon is a dietitian working in Nutrition Support and is team leader for the adult Nutrition Support Team which is part of Birmingham Community Nutrition. At the time of the study Marie Henson was a Community Nurse team leader in the Kings Heath area of Birmingham, which is where the study took place. This study was presented as a poster at BAPEN Conference 2016 and was published here.

The prevalence of dehydration in older people in the UK has not been widely studied. The UK DRIE Study found 20% of residents in UK long term care were dehydrated. The prevalence in those living at home has not been determined. Dehydration in older people is linked to associated morbidities such as increased falls, confusion, and infections and is a frequent cause of hospitalisation. Clear signs of early dehydration in older people are yet to be determined, but there is a need to identify those at risk of dehydration and intervene early. Systems for recognising those with inadequate fluid intakes, and helping them to drink more, are already in place in many UK hospitals where a red jug scheme identifies those requiring assistance to drink.

How (I try!) to avoid a hospital admission for someone with frailty

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

The bag I take on every home visit has numerous pockets with endless equipment and forms required at my fingertips. I clip the same badges and emergency kit to myself at the start of every shift and I take this order and strict routine with me into environments over which I have little control.  It is within this mix of structure and chaos that the creativity to manage conditions and sometimes crises within a community setting arises.

Publications and conferences have explained the importance of avoiding unnecessary hospital admissions (especially for those with frailty) and commissioners require data on the number we have achieved.

A Warm Glow in Solihull

Maxine Burrows and Yvonne Obaidy are Collaborative Leads for Early Help 0 – 19 at Solihull Metropolitan Council.  They develop high quality sustainable services for children, young people and families.  In this blog they talk about a new intergenerational pilot that they are working on and how they are enjoying the challenges and diversity that this work is providing.  Dr Zoe Wyrko (Consultant Geriatrician. Associate Medical Director – Quality Development, University Hospitals Birmingham) is providing them with support and help as needed, including evaluation tools for the older adults. You can follow them at @EngageSolihull

We are carrying out a pilot of intergenerational working in Olton, a district of Solihull in the West Midlands, with two local partners – St Bernard’s Residential Care Home for older adults and Tender Years Day Nursery. The care home has lovely cosy rooms – which are not huge, and the nursery has transport for five children so we chose to do a small pilot involving just five older adults to start with. Our intergenerational activity takes place every Wednesday at 10.30am for one hour.

We had several preliminary individual meetings with the nursery and the care home and then all parties came together for a final planning meeting two weeks before the pilot started. The meetings were useful for clarifying roles and responsibilities and planning some of the activities.  Most importantly the final meeting enabled the care home staff and nursery staff to meet and share their reasons for taking part in the pilot.

We must do more to ensure no-one misses out on rehab

Professor Karen Middleton is Chief Executive of the Chartered Society of Physiotherapy. Karen is a Fellow of the Society of Orthopaedic Medicine, and, in that capacity, has taught physiotherapists and GPs on a national and international basis. Here she discusses the report Recovering after a hip fracture:
helping people understand physiotherapy in the NHS.

It’s the overwhelming feelings of regret and loss that get me. Every time. Whenever I hear a family member say they ‘can only wonder what might have been’ or a patient talking about what they can no longer do.

Whenever I see our Rehab Matters film I know that the fictional story it depicts is playing out in real life, behind closed doors, in homes across the country. It cuts deeply, as a physiotherapist, to hear these stories of how a lack of access to rehabilitation has changed a life.

It makes me burn at the injustice of so many people missing out. Because I know how access to high-quality rehabilitation can change a life for the better – how it can return a person to the things they love, and to the things they do with the people they love. How it can restore independence and a sense of self-worth. How it can restore a life; how it can save a life. 

Making the most of our assets

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

The Reimagining community services report (Kings Fund 2018) highlights the need for strengthening community services with the aim of supporting our  older population, bringing to reality the vision set out in the NHS Five Year Forward View.

Unfortunately, the concept of reimaging services brings about concerns with growing financial and workforce pressures, these pressures could have a huge effect on the delivery of the recommendations. This could have a major impact on the ability of service providers to deliver services to meet the needs of the service user.

The Reimagining Community services report suggests that radical transformation of community services is required.  This would mean an additional share of the NHS budget. The NHS budget would be given to these services in order to make effective use of all the assets with our community. 

Predicting who will be admitted to a care home from hospital?

Jenni Burton is a Clinical Research Fellow in Geriatric Medicine funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh. Here she discusses the results of two linked systematic reviews of predictors of care home admission from hospital. She tweets @JenniKBurton.

Care home admission from hospital has long been recognised as an area of significant variation in practice (Oliver D et al. 2014. Making our health and care systems fit for an ageing population) and one which remains a strategic target to reduce across the UK. However, more than half of care home admissions each year in Scotland come directly from hospital settings. It is therefore important to explore the predictors of this life-changing transition to help inform prognostication, communication with individuals and their families, service planning and the extent to which we can intervene to prevent or modify this outcome. 

Hidden Carers – sharing the stories of older male carers

Louise Bate is an Engagement and Communications Officer with Healthwatch Dorset. Healthwatch is an independent watchdog, working to help people get the best out of their local health and social care services. Healthwatch enables local people to influence the delivery and design of local services, by sharing their views with health and care commissioners and providers: www.healthwatchdorset.co.uk 

More than 51,000 carers in England are men aged over 85; a number that has more than doubled in the last decade. It’s such a huge number of people that it’s hard to imagine. We wanted to make the numbers real – so we’ve been working with Bournemouth University and the Carers Support Service to listen to older male carers, gather their stories and give them a stronger voice.

Carers over the age of 85 are the only demographic of carers where men outnumber women (59%). Men are more likely to become carers in older age than at other times in their life and usually as a result of caring for their partners.