Loneliness; A public health epidemic

Helen Stokes-Lampard is Chair of the Royal College of General Practitioners (RCGP), the UK’s largest Medical Royal College, representing over 52,000 family doctors across the UK. She is a part-time GP partner at The Westgate Practice in Lichfield, Staffordshire, and was the Head of Primary Care Teaching (undergraduate) in the Medical School of the University of Birmingham until becoming RCGP Chair. She will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

As a GP in the Midlands, I see patients in my surgery day after day with a variety of different health needs. We GPs are privileged to be the cornerstone of our communities, and the vast majority – over 85% of people – come to see their GP at least once a year.

Last year, at my speech to RCGP Annual Conference, I introduced the world to my patient, Enid, a character who every GP will recognise from their own surgery and their own community. My inspiration for this character stems from the type of patient which every GP will be aware of: she’s 84, she has hypertension and type 2 diabetes, and has intermittent flares of osteoarthritis pain in both her hips. Most significantly, she recently lost Brian, her husband of 62 years.

September 2017 issue of Age and Ageing journal is out now

The September 2017 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.  

Hot topics in this issue include:

The future of Comprehensive Geriatric Assessment

Causes of unsafe primary care

Improving medication adherence after hospital discharge

Oral health in hospitals and care homes

Research methods: how to do a systematic review

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

Geriatric conditions, are they recognized as relevant problems by community dwelling older people?

Marjon van Rijn is a PhD candidate at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam and lecturer at the School of Nursing, Faculty of Health, Amsterdam University of Applied Sciences the Netherlands. In this blog she comments on her recent paper in Age and Ageing.

Comprehensive Geriatric Assessment (CGA) is increasingly implemented in community care settings and involves an assessment of physical, psychological, functional and social geriatric conditions, such as urinary incontinence, memory problems, fall risk and loneliness.

In this study, CGA is part of a complex intervention to prevent disability in community dwelling older people. Older people with an increased risk of functional decline, according to the Identification of Seniors at Risk questionnaire that was validated for primary care, were invited for a CGA at home. A community care registered nurse visited older persons to conduct the CGA, and if necessary, made an individual care plan with several follow up visits.

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.

Urgent Care: The Value of Occupational Therapy

Karin Orman is Professional Practice Manager at the College of Occupational Therapists

The College of Occupational Therapists published a report on the value of occupational therapy across urgent care at the start of Occupational Therapy Week in November. The report argues that urgent care is a term that encompasses a wide range of services and settings from primary care to care homes. Traditionally occupational therapists have been commissioned to work in secondary services but increasingly the profession is developing roles within primary care and with non-statutory providers such as housing associations offering timely, short term interventions that reduce or delay the need for more complex support and packages of care.

“We’re onto something big here” – where next for the Barker Commission?

Ed Gillett is the British Geriatrics Society’s new PR and Communications Manager. He tweets at @ehgillett and @gerisoc

Having only joined the BGS in August, I got my first taste of a large-scale event last week at The King’s Fund, with the launch of the final report from the Barker Commission on Health & Social Care.

I’ll be honest: it was a slightly intimidating experience initially. The sheer weight of intelligence and experience in the room was something to behold, from senior NHS directors and media figures to the heads of numerous NGOs, thinktanks and specialist organisations. It was a room full to the brim with big names and heavy hitters; the only notable absentees were the major political parties, at least on the Commons side of things.

It immediately became clear why this was the case, on both counts. As Dame Kate Barker outlined the core recommendations of the report, I was struck by how bold and ambitious they were; surely the sort of thing which demands high-level attention and debate, but which could also give your average Whitehall spin doctor the odd heart palpitation.

BBC documentary series ‘Protecting our Parents’

Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series

The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team.   The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.

Year of Care Explained

By Eileen Burns and Amit Arora

Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.

Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need.

Unco-ordinated care: we need named responsible clinicians in hospital too!

Ron Murphy is a software designer, he blogs at ronmurp.net 

I read the “Named clinicians …” post today, and the linked post by Prof David Oliver. It addresses continuity of care after discharge. This is a concern, as he quotes, “we need to know that there is a clinician accountable for vulnerable older people in the community, just as there is in hospital”.

The toxic cocktail that leads to patient complaints – how can the NHS line its stomach?

Dr Claire Dow is Consultant Physician at Barts Health NHS Trust. She tweets at @ClaireDow1

Think not of what you can do for your complainants, but what your complainants can do for you. (Apologies to President Kennedy.)

At the recent BGS/RCP conference on Acute Care of Older People, we were privileged to hear Dame Julie Mellor talk about patient complaints from her perspective as Parliamentary and Health Service Ombudsman.

For an audience composed mainly of Geriatricians and Acute Physicians, it came as no surprise that she felt that hospitals are poorly equipped to deal with the older people who have multiple conditions.