1. Supporting Carers in General Practice & role of RCGP GP Champions for carers Dr Sachin Gupta GP, Welwyn Garden City RCGP GP Champion for Carers, East of England Macmillan GP

2. Why GPs & Commissioners should support carers How GPs can support carers- simple steps Role of RCGP Champions for carers

3. Win-win situation Supporting carers in general practice is a win win situation for everyone. For carers - Improves their wellbeing - Prevents illnesses in carers, - Improves their ability to provide better care For GPs & NHS Reduction in referrals to -social services for professional care at home

4. Win-win situation Reduction in referrals for - NH/RH placements- study in Herts suggest 17% RH admissions due to carer breakdown - Hospital admissions - Improves health and wellbeing of carers & person cared for Study tracked people aged over 75 years and found that 20% of people needing care were admitted to hospital because of breakdown of a single carer. Admissions, needs and outcomes’; Mittelman M et al (1996), Brodaty H et al (1997); Dröes, R et al (2006)

5. Examples of good practices in East of England Herts Valley CCG project- every practice has a Carers Champion funded by CCG Carer friendly community project (Stevenage) - will demonstrate the effectiveness of certain interventions to be evidenced Carer friendly hospital (Lister Hospital) to implement interventions at specific 'trigger points' in the caring journey which will delay admission to residential care and/or escalation to acute medical services Carers break prescription service (Cambridge)

6. Reasons for Carer friendly projects 1) Significant numbers of permanent residential care admissions are the result of carer breakdown - A previous study of Hertfordshire pathways into residential care has indicated that 17% of permanent residential care admissions are due to carer breakdown.

7. 2 Low level support to carers has been proven to have an impact on delaying residential care admissions and hospital admissions- International random controlled trials have shown that early intervention to support carers results in significant delays in admission to residential care, and an up to 28% reduction in admission in comparison to control groups. Source: Bebbington et al (2001), ‘Care Homes for Older People: Volume 2. Admissions, needs and outcomes’; Mittelman M et al (1996), Brodaty H et al (1997); Dröes, R et al (2006)

8. 3) Carers make a huge and increasing contribution in terms of the care they provide to their partners, relatives and friends- It would cost the state £2.1bn if it were to pay for the hours of work carers do to support their cared for in Hertfordshire Herts population of those with aged 65+ will rise from 166,700 in 2009 to 251,800 in 2030. Currently, there are approximately 138,000 carers in Hertfordshire. In 2017, there will be a ‘tipping point’ for care when the numbers of older people needing care will outstrip the numbers of working age family members currently available to meet that demand. The number of carers nationally is set to increase from 6 million today to 9 million by 2037.

9. Expected benefits Carers have a life outside caring (breaks to support other outcomes) Carers stay fit/healthy and are safe Carers feel respected as carers, as partners in care Reduction of £50,000 in permanent residential care costs by delaying residential care admissions through the carer friendly community and carer friendly hospital

10. Benefits continued.. If the benefits of Phase One are realised, then following benefit is expected to accrue from phase two over four years: - Reduction of £3m in permanent residential care costs by delaying residential care admissions through the roll out of the carer friendly community and carer friendly hospital model -will result in delaying 8 residential care admissions by one year

11. Effect of prescription break Carers risk of depression before and after a PCT funded break, as measured by SF12 screening (based on 137 pre- and post- support questionnaires

12. What can GP’s do Develop practice action plan to identify and support carers -Use RCGP & PRTC action guide for GP’s and their practice staff to support carers -Five Keys ways for GPs and primary care team to support carers a) Listen b) Think of depression c) Ask about finances d) Signpost to services e) Plan for emergencies

13. Identify a Carers Lead Identify carers proactively Screen carers for depression annually, invite carers for flu vaccination Signpost carers to help them to perform their caring role Refer carers for social services carers assessment Ensure carers have an emergency plan in place.

14. - Raise profile of carers at all levels - Inclusion of carers into CQUINS - Carers representation at CCG Stakeholders forum - Carers engagement with service redesign and identification of local priorities - Work with Local authorities, council and other stakeholders to support and develop services for carers eg Herts Valley CCG project to support carers, Carer friendly projects in E&N Herts What can CCGs do ?

15. “to champion, advise and support carers initiatives, events and commissioning within each region” Role of the GP Champion

16. Regions 10 Regions Based on previous Strategic Health Authority areas??

17. Expert Practitioners GP Champions Carer Ambassadors Supporting Carers GP Liaison Staff Primary Care Trusts Practice Teams Patient related groups Carers Leads Voluntary Sector organisations Clinical commissioning groups Local Councils Primary Healthcare community GPs

18. Work done so far.. Raised awareness in primary health care professionals - Practice visits, practice managers forum - Attending Locality and CCG events/ meetings Trained GPs/ GP Registrars & nurses to identify and support carers Worked in partnership with CCGs & commissioners on local initiatives Proactively supported carers initiatives Collected and shared examples of good practice Promoted use of ‘action guide’ Assisted in development of RCGP commissioning guidelines Developed relationships with other stakeholders Advised & assisted on local projects eg carer friendly projects in Herts

19. Questions & Answers