Care Home GP - A challenge that became an opportunity to innovate
Dr Sonali Kinra has been practising as a GP for the last 10 years. Over this time she has had the opportunity to lead on the care they provide within their practice for special cohorts of society such as the older population living in care homes, people with learning disabilities and asylum seekers. She tweets @SonaliKinra
I joined my current practice as a partner 8 years ago. The partner I was replacing had the lead role of providing care for older people in a residential care home primarily with dementia and hence I was automatically expected to provide medical care for this subgroup.
During my training I did not receive any specific training towards providing care for this cohort. It was indeed challenging but with time it has become the most enjoyable part of being a GP – enabling me to provide personalised, multi-disciplinary, patient-centric care.
In the initial few months of establishing my role I suggested to my practice that I would need extra time to review the records of all the residents in the care home. If I was going to do this I wanted to know these residents fully and what mattered to them. The medical records not only gave me an insight into their physical and mental health but also insight into the person they were and the lives they had lived before coming to live in the care home. Stories of stoic men and women who had seen it all - been through the wars, raised children while also earning a livelihood, teachers educating the next generation, an avid horse rider, another a surgeon and an anaesthetist to name but a few.
This activity helped me draw out a summary of the personal, individual characteristics as well as any outstanding investigations or hospital appointments that might have been overlooked during transfer of care, while also adding reminders for frailty/chronic disease reviews.
Following this I organised meetings with the resident and their family, revisited the physical and mental health issues identified and introduced concepts of advanced care planning.
Again, this was something I did not receive formal training on but I was determined to make this a part of our conversation as we embarked upon the journey of shared decision making. During these conversations we discussed what mattered most to these people and their families and how best we could look after them. Every opportunity to engage helped develop trust and familiarity with the residents and their families, which ultimately facilitated discussions around end of life care.
Working in this role as a Care Home GP I learnt from, led, enabled and empowered multidisciplinary teams that comprised advanced care practitioners, clinical pharmacists, community geriatricians, falls teams – all of whom were working in the interest of the patient. I also invited representatives from Age UK and other voluntary sectors to help improve care provision.
Akin to a birth plan for a pregnant couple I promoted an ‘ageing and dying well’ plan in the care home. The provision of care at our care home developed naturally and organically to best suit the needs of the residents.
Through our concerted efforts we documented a 27% reduction in acute ED attendances. The practice received an ‘outstanding’ rating for the care of older people in the CQC report in 2016. I continue to visit the care home on weekly basis and have also now trained my practice nurse to conduct annual frailty reviews with rationalised blood tests.
If you’ve ever had a doubt about becoming a care home GP take a leap of faith - you won’t regret it! Better still, bring along your FY2 and GP Registrars on care home visits and open their minds to the endless possibilities of this field of medicine.