BGS GeriGPs Group and the NHS Long Term Plan
The NHS Long Term Plan was published in January 2019, bringing commitments to break down the historic divides between health and care services and different parts of the NHS. The new Primary Care Networks will be aligned with expanded community teams of GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs to create fully integrated community-based healthcare. As the care of older people makes up a significant proportion of the workload of GPs and other health and care professionals, it will be important for GPs interested in the care of older people to be recognised as a key component of Primary Care Networks.
GeriGPs at the British Geriatrics Society
The GeriGP group of the British Geriatrics Society (BGS) was formed in 2017 to connect GPs with an interest in the care of older people. The group aims to share good practice and support the development of new roles for GPs in this area. The group recognises that while there are a range of roles for GPs supporting care of older people, there is a lack of awareness about these roles as well as inconsistency in relation to employment status, contracts, pay, appraisal and revalidation, qualifications, training and ongoing professional development and support.
A recent survey of the GeriGP membership found that:
- There is significant variation across the GeriGP workforce with respondents working in a range of settings including traditional general practice, frailty hub units, community hospitals, care homes, interface roles and secondary care. While there is a need for some standardisation, there is clearly the potential for flexibility, making these roles attractive for GPs.
- 87% of GPs who responded state that their GeriGP role has increased the likelihood of them continuing to practise medicine. Greater understanding of this role could help to reverse the trend of GPs choosing to take early retirement or to leave general practice before retirement.
- Many GeriGPs report that they are more professionally satisfied than they were in traditional primary care settings with ten-minute consultations and purely reactive home visits.
- Widening the availability of GeriGP roles has the potential for increasing the retention of highly skilled, experienced GPs who will be able to lead and support teams working with older people in community, intermediate and interface care environments to promote high-quality person-centred care. In addition, the flexibility provided and the job satisfaction experienced by many GeriGPs could prove to be attractive to younger GPs – thus securing the next generation of leaders.
The Ageing Well workstream of the NHS Long Term Plan
As part of the NHS Long Term Plan, the Ageing Well workstream brings three key developments which have the potential to make a significant impact on the care of older people:
- Urgent community response and recovery support – within five years all parts of the country will be expected to have improved the responsiveness of community health crisis response services to deliver the services within two hours of referral, in line with NICE guidelines, and where clinically judged to be appropriate. In addition, all parts of the country should be delivering reablement care within two days of referral to those patients who are judged to need it. This will help to prevent unnecessary admissions to hospitals and residential care, as well as ensuring a timely transfer from hospital to community.
- An investment of £4.5billion will fund expanded community multidisciplinary teams aligned with new primary care networks. These are based on neighbouring GP practices that work together, typically covering 30-50,000 people. Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs.
- NHS England’s Enhanced Health in Care Homes (EHCH) Vanguards have shown how to improve services and outcomes for people living in care homes and those who require support to live independently in the community. The NHS Long Term Plan commits to the upgrade by 2023/24 of NHS support to all care home residents who would benefit, with the EHCH model rolled out over the whole country. This will ensure stronger links between primary care networks and their local care homes, with all care homes supported by a consistent team of healthcare professionals, including named general practice support.
How can GeriGPs help with the implementation of the NHS Long Term Plan?
As Primary Care Networks are established, the involvement of GeriGPs – and further development of these roles – can help to ensure that the new structures work in the best interests of older people and that NHS resources are appropriately used. The implementation of Primary Care Networks means that care will be delivered closer to patients’ homes with community-based support. As secondary care struggles to meet the demands of the ageing population, more frailty-related services will be developed at the front door of hospitals and reactive admission-avoidance services in the community. These services need to be led by highly experienced risk-tolerant clinicians as part of that reactive team in order to make appropriate decisions based on context and patients’ currently or previously expressed wishes. GeriGPs would be ideally placed to provide that clinical support and ensure that the most appropriate care is provided at the most appropriate place and time.
As the NHS Long Term Plan is implemented across England, the opportunity exists to develop GeriGP roles in larger numbers within the healthcare sector. With the twin focus on care of older people and on care in the community, GeriGP roles bring the skills and experience to straddle these two areas perfectly. They understand the language and screening of frailty and are able to translate screening tools into follow-up action, within the constraints of the primary care workforce. GeriGPs can play a vital role in ensuring that frailty is core to the work of primary care networks, and that primary care networks are doing all they can to prevent the onset of moderate or severe frailty.
Opportunities for joint working
The UK’s population is ageing rapidly and this presents a challenge to the NHS in terms of delivering urgent care, putting in place advance care planning and ensuring that the workforce is adequately resourced and trained. Investing in training and education to support the role of the GeriGP is an effective route to maintaining and improving the quality of care older people receive. Education, training and learning activities need to be adequately resourced and competency-based to reflect the varied roles of GeriGPs and the different settings in which they work.
Standardising and clarifying the role of the GeriGP would enable commissioners and GPs to understand the benefits which the GeriGP role can bring to the delivery of better healthcare for older people, and how GeriGPs can be supported to be effective. This clarity regarding employment status would also mean that GeriGPs can access support with pensions, appraisals and revalidations.
GeriGPs and the GeriGP group of the BGS offer a constructive solution to some of the challenges facing the NHS, and can contribute to enabling the NHS to deliver the best possible care to older people.
 Membership of the GeriGP group at the time stood at 100 and the survey had a response rate of 47% - well above average for surveys of healthcare professionals. (Bonevski, B et al, 2001, Response rates in GP surveys, Australian Family Physician, 40: 6 https://pdfs.semanticscholar.org/97be/525238c362a8f68492457e60025610f16d43.pdf?_ga=2.6251125.730856989.1556704293-1456657593.1556704293)