Tribalism Kills; The Journey Towards Genuine Integration

David Attwood is a GP with a Specialist Interest in Older People. He is a Committee Member of BGS’s GeriGP Group. He tweets @DavidAttwood12

“You have twenty-one children?!” I asked incredulously. The Fanta that was halfway to my mouth almost left my hand to land on my khaki coloured trousers.

“Yes, twenty-one.” William replied, between mouthfuls of Nile perch. After a pause to finish chewing he casually added, “and four wives.”

The Fanta fell out of my mouth to land on my trousers.

“Do they all get on well?”

He screwed his face and smiled mischievously “No! They are constantly arguing!!”

I had to laugh.

It’s not how old you are that matters, so much as how you are old…

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

While celebrating successful ageing we must not be led into complacency. There is marked inequality between least and most socioeconomically deprived areas with men living on average up to 8 years less in the most deprived areas.

The NHS England Five Year Forward View notes that support for frail older patients is one of the three areas that the NHS faces particular challenges. It is therefore potentially game-changing that we are now making positive steps towards addressing this through routine frailty identification and promoting key interventions targeted at falls risk identification and medication review.

A New Holistic Approach to Pain Management in Older People

Nan Ma is specialist registrar in clinical Gerontology and Aza Abdulla is a consultant geriatrician and general physician at the Princess Royal University Hospital, Kings College NHS Foundation Trust. He is co-founder of the Special Interest Group on Pain in Older People in the British Geriatrics Society (BGS) and participated in producing the first National Guidelines on Management of Pain in Older People. He is also the immediate past president of the Geriatrics & Gerontology Section at the Royal Society of Medicine.

Pain in older people is under-reported and often poorly appreciated. For many, it is seen as part of normal ageing and has to be accepted. It is also a subjective feeling (different people have different pain thresholds) making it difficult for the clinician to quantify its impact in an individual patient. Consequently, it may be overlooked as an important factor that can affect older people’s wellbeing. In fact, chronic pain has a huge influence on quality of life (QoL) through its effects on the physical and mental state, which in turn adversely impacts on the older individual’s economic and social status (effects on carers, friends and family). Inadequately controlled pain perpetuates disability, anxiety, and depression all interfering with the overall QoL. It follows that effective management of pain is crucial in optimising welfare in the older person.

Multi-morbidity – the case for change

David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.

Generalists are the solution.

For too long policy makers have ignored what clinicians on the front line have been telling them, people with multiple conditions not only exist but are the mainstream.

It is our failure to recognise this fact that has put pressure in the system as the NHS struggles to keep its head above water especially when one adds social factors, depression and mental health into the mix of complexity.

The RCGP “responding to the needs of patient with multi-morbidity” has created a powerful case for change with the need to substitute ever-increasing investment into super specialism by a call for the generalist to support those with multi-morbidity in the community.

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

A new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital.

Working as an Extensivist GP

Dr Margaret Lupton is a GP in North West England with over 20 years’ experience in General Practice. She joined the Blackpool, Fylde and Wyre Extensive Care Team in January 2016. She is one of the key speakers at the BGS Autumn Meeting during the Community Geriatrics Afternoon on Wednesday 23 November. She tweets as @magsielodge

I have been a GP for 20 years and over this time I have witnessed the patient population becoming gradually older with increasingly complex problems. Also, GPs have become more and more involved in their patients’ chronic disease management. The standard 10 minute GP appointment just isn’t long enough anymore to deal with these older patients who have complex needs. For a long time I have been interested in exploring new ways of working and new models of care and so when I got the chance to join the Blackpool, Fylde & Wyre Extensive Care Service, I jumped at the chance.

Comprehensive Geriatric Assessment in Primary Care

Lynn Lansbury is NIHR CLAHRC Principal Investigator in Academic Geriatric Medicine at the University of Southampton. Here she talks about CGA in Primary Care, which she shares on Twitter @CGA_GP

Adam Gordon’s blog introduced a timely study. With an ageing population it is important that we develop services that are fit for the changing demographic. There is convincing evidence that Comprehensive Geriatric Assessment (CGA) has a place in best practice for the care of older people. The evidence base is particularly strong in acute settings and studies have also been carried out in people’s homes. The Proactive Healthcare for Older People in Care Home (PEACH) study explores CGA in care homes Thus there is interest in identifying the place of CGA in other settings. Our new study, Comprehensive Geriatric Assessment in Primary Care (CGA-GP): The Fit for Later Life Project funded by NIHR CLAHRC Wessex, investigates the GP surgery as a setting.

What happens to patients with abnormal cognition picked up by in-hospital dementia screening – Results from GP questionnaires

Sarah Pendlebury is Associate Professor in the NIHR Oxford Biomedical Research Centre and the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford and Consultant Physician and Clinical Lead for Dementia and Delirium at the Oxford University Hospitals NHS Foundation Trust. Research and audit interests include cognitive impairment associated with cerebrovascular disease and the interactions between vascular disease, neurodegeneration, co-morbidity and delirium and in the use of short pragmatic cognitive tests in patients with stroke and acute illness. Here she reports on an audit of the actions undertaken by GPs in response to letters informing them of in-hospital identification of cognitive impairment in their patient, which will be presented at the upcoming BGS Spring Meeting in Liverpool.

Dementia and delirium are prevalent in older patients with unplanned admission to hospital and are associated with death and increased dependency, but many confused patients do not have a dementia diagnosis prior to admission. Routine dementia screening for older people (>75 years) hospitalised as an emergency is mandatory in England with onward referral for specialist assessment in those identified as at-risk (dementia CQUIN).

‘A welcome with tea and cake’: Making the most of your care home GP

Aileen Jackson is a senior project manager for the dementia and diabetes programmes at the Health Innovation Network (HIN), the Academic Health Science Network for South London @hinsouthlondon

The Health Innovation Network (HIN) for South London like the BGS has an active programme to work with care homes to learn about, share and spread and adopt good practice in South London. During our last biannual care home forum we held a quick fire Q&A session led by two South London GPs Dr Nwakuru Nwaogwugwu and Dr Charles Gostling asking the question ’How do you get the best out of your care home GP?’ Everyone agreed that a good common denominator was to ensure that the GP was welcomed with tea and cake hopefully prepared and baked by the care home residents.  The forum then set to work on developing the basis for really useful HIN guide for care and nursing homes to get the most out of their GP. It was acknowledged by all that sometimes the GP care home relationship can be quite fractured due to genuine pressures on both GPs and the care home sector and the lively and interactive discussion provided a platform to discuss problems for GPs and care homes such as time constraints, a lack of confidence, training issues, external pressures and staff retention.

Have you got access to Summary Care Records?

Dr Emyr Wyn Jones is Clinical Ambassador at the National Implementation Summary Care Records Service: he tweets at @emyr_wyn

Were you aware of the existence of Summary Care Records (SCRs)?  They are mentioned in one of six Quick Guides that are included in a section of the NHS England website on Transforming Urgent and Emergency Care.

Almost every person in England now has a Summary care Record (SCR).  To be exact, more than 55 million people or 96% of the registered population have had a SCR uploaded electronically from their GP record to the National Spine.  This number is still increasing.  In the foreseeable future, an SCR will have been created for everyone in the country apart from those people (only 1.4% of all those who were contacted) who have indicated that they wish to opt-out of having a SCR.