Workshop for the Frail Elderly Dr David Hill GP and Lead for unscheduled care ESyDoc East Surrey Clinical Commissioning Group

Kings Fund enabled GP and Whole System Leadership Programme To optimise the care for the frail elderly population around Surrey and Sussex Healthcare Trust Surrey and Sussex Healthcare Acute Trust - senior managers and consultants Community Providers Mental Health Trusts Social Services Ambulance service Out of Hours Provider Clinical Commissioning Groups / PCT commissioners GPs – commissioners and provider

“Best Care delivered, Seamlessly” Improving hospital discharges Optimising Mental Health input (esp dementia, liaison services) End of life care Supporting Care Homes Information sharing

Supporting Care and Nursing Homes Understanding challenges from providers’ perspective 2 short presentations - Dr Natalie Powell SASH Dr Radcliffe Lisk Ashford and St Peters Solutions to the challenges faced

Recommendations from Quest for Quality Commission services and service specifications to support care homes Care home residents at centre of decisions about their care - care planning to include place of care and end of life care planning Integrated healthcare services – primary medical and nursing care together with mental health, care of the elderly hospital departments, palliative care, rehabilitation NHS should clarify obligations to care home residents

Challenges for GPs 61% - Current arrangements for medical care of patients in care homes unsatisfactory 68% - Care home work major source of stress for GPs 73% - Lack of support or resources to manage patients in care homes safely

Old age Psychiatrists 87% worked with care homes 64% not specifically commissioned to do so

Geriatricians 40% felt medical support to care homes below average or poor >70% depression and dementia not optimally managed >50% incontinence and end of life care could be better managed 73% wanted greater involvement in care home work 30% involved in initiatives to support care in care homes – only half allocated time in job plans 18% unsuccessful in securing PCT funding for such initiatives 45% reported PCT initiatives not involving their departments 90% PCTs reported initiatives – mostly involving community matrons

Care Homes GP input – 1 or 15? – Continuity of care District nurses reluctant to go into nursing homes eg male catheterisation Limited access to physiotherapy and OT Different attitude to access – residential homes vs nursing homes Out of hours care – “send to hospital”, lack of available information re planned care Care home priorities set by social care rather than healthcare Lack of confidence of care staff Policies operating in care homes e.g. medicines available for emergencies e.g. oral steroids and antibiotics for acute exacerbation of COPD. Care homes cannot stock drugs other than homely remedies