Broadening horizons through international collaboration – the Anglo-Dutch Experience

As the Dutch government has sought to rationalise care of older people with frailty, supporting more care at home prior to moving to a nursing home, so elderly care physicians have found themselves seeing patients in their homes.  As more patients have received step-down rehabilitation in nursing homes, so Elderly Care Physicians have become more specialised in geriatric rehabilitation.  As discharge planning from acute hospital has become more complex, so Elderly Care Physicians have begun to provide in-reach assessment services to support discharge planning.

There are1600 elderly care physicians in the Netherlands, compared with 225 Hospital Geriatricians.  It’s as if the UK model of specialty geriatrics was flipped on its head, with community geriatrics making up the bulk of the work, rather than being a fringe (albeit growing) discipline. In working with Elderly Care physicians, the opportunity for organisational learning is considerable.  In Britain we’re trying to understand how GPs (with or without geriatricians) can support care homes in more effective ways, and we’re trying to work out how geriatricians can support Discharge to Assess Programmes using community based rehabilitation facilities.  Our ability to experiment is limited by the fledgling nature of most community geriatrics services and the way in which our primary care colleagues find themselves always over-stretched. Dutch Elderly Care Physicians, because of their greater numbers, can innovate around community services at greater scale and pace. We can learn a lot by watching what they do and listening to what they learn.  

In turn, Elderly Care Physicians can learn things from us.  Sub-specialty geriatrics is much more fully developed in the UK and provides a possible template for how Elderly Care Medicine can develop as these doctors move away from being a discipline working exclusively in nursing homes to support a wider patient base. Academic geriatric medicine in the UK – despite our own worries that we are a Cinderella academic discipline – is more fully evolved than Academic Elderly Care Medicine is in the Netherlands.

I had been visiting and learning from Dutch colleagues for some time when, working with Professor Wilco Achterberg and Dr Monica van Eijk at the Leiden University Medical Centre, we decided that we wanted to extend the benefits of similar learning opportunities to our doctors in training.  We have been running our exchange programme for two years.  Three UK trainees have visited Leiden, funded by Health Education East Midlands, and one academic registrar from Leiden has visited us in the East Midlands.  Two more are scheduled to visit before the end of this year.  Registrars from both countries have shadowed clinical services and “walked the care pathway” for patients in the host country.  This has enabled them to contrast and compare their experience of the host country with their home country and has allowed them to spot opportunities for service development and improvement.  Our Dutch visitor, Anouk, implemented a weighted functional comorbidity index in a UK community hospital and, by doing so, learned about research governance and delivery in a UK setting in addition to the clinical experience she gained. Our UK trainees have been able to participate in multinational symposia at the EUGMS explaining the benefits of the exchange programme, what they have learned and why they’re now better equipped to do their job than if they’d stayed at home

Two of our UK trainees are now working with registrar colleagues in the Netherlands to develop video-link training sessions which will be delivered several times per year to extend the benefit of educational exchange between countries to more of their colleagues. This is an exciting next step.  They plan to evaluate this work and, with a bit of luck, land their next multinational symposium at an international conference.

This would be junketeering if all our British doctors brought home was stroopwaffles and Delft pottery and all our Dutch colleagues took away was some Fortnum and Mason goodies and Harry Potter souvenirs.  But they bring back and take away so much more. The benefits all round are broader horizons and a sense of perspective about “the way things work”. This, in turn, fuels imaginative approaches to service design and delivery.  Our Dutch colleagues share the same demographic challenges to service provision that we do.  By sharing our experiences, our successes and failures, both sides get a bit closer to the type of understanding needed to rise to these challenges.

Adam Gordon
Clinical Associate Professor in Medicine of Older People
University of Nottingham