ECHO 3 Working with GPs 27.11.17

Today …. Look at a tool developed by a GP working with care homes in South London to see if this could help you in your work Signpost you to national work that can support you in discussions with GPs

General Points Remember that you deserve to be treated with respect as a fellow professional – “polite assertiveness” - when interacting with colleagues Do you have regular review meetings with the GPs? How can you maximise effectiveness of these? The C.A.R.E H.O.M.E G.P. Tool…

https://britishgeriatricssociety. wordpress https://britishgeriatricssociety.wordpress.com/2016/04/19/a-welcome-with-tea-and-cake-making-the-most-of-your-care-home-gp/

C.A.R.E H.O.M.E GP

C.A.R.E C: Coordinate & Communicate A: Assess Talk to your colleagues and prepare a ward list that can be faxed to the GP before the ward round. Include residents you are worried about, check care plans and DNACPRs are up to date. A: Assess Does the resident need a pain, memory or mood assessment? Include nutrition and hydration Observations if appropriate: eg blood pressure, blood glucose, 02 saturations, pulse, Urine dip - but what else have you seen or heard? issues. R:Record your observations: Present the GP with clear, concise dated records. Highlight documentation in the notes issues of concern and changes in behaviour E: Engage residents and families Speak to the residents& families, understand what is important to them Ensure you communicate their needs and wishes to the GP if they are less able to themselves.

H.O.M.E H: Hospitals: O: Opportunity: M: Medication management: Has the resident been admitted, discharged or had an out-patient appointment? Keep the GP informed. O: Opportunity: Take the GP visits as an opportunity to work together. Explain /highlight any other issues that are going on at your home, eg staffing levels, CQC visits, new training or activities etc. Share good news too. M: Medication management: Highlight any worries about administration of medication. Allow enough time for monthly prescription requests; consider submitting in week 1. Acute medications: remember to include the frequency and quantity you need. GP needs to review residents’ medication periodically whether or not any concerns about them. E: Experts in the community: Refer if you need to; there is a wide range of community services e.g. podiatry, tissue viability, diabetes, mental health, dietetics, wheel chair assessment team….don’t all need to wait for the GP. Record the referral and keep GP Informed.

G.P G: GP ward round/visit: P: Prioritise, Plan, be Proactive: Identify the nurse/carer who is managing the ward round? Ensure you have your medications administration records (MAR) charts and relevant paperwork is ready. Try to ensure a member of staff accompanies the GP for the whole ward round. P: Prioritise, Plan, be Proactive: Prioritise residents on basis of need, proactively think of any suggestions you can contribute, remember advanced care plans. Document the plans for the resident following the GP review share recommendations with those who need to know e.g. the resident, relevant staff, and families /carers Put into action. Document the impact of any changes for the next GP ward round.

Working with GPs Out of hours Different relationship as you will not necessarily know the GP BUT Consider using part of CAREHOMEGP (first part-CARE) or use SBAR ( previous session) to give the information Let GP know: if resident on CmC, DNACPR, ACP (including ceilings of care) in place and whether known to palliative care team In cases of disagreement: proactively call for advice/suggest GP calls for advice eg to palliative care on call team, even if patient not known to them Situation Background Assessment Response

National work for further reading and to inform discussions with GPs and other colleagues: 1.NHS England 2.SCIE

NHS England enhanced health in care homes (ECHC) framework Sept 2016 https://www.england.nhs.uk/wp-content/uploads/2016/09/ehch-framework-v2.pdf 6 vanguards across England with good examples of care including effective working with GPs

To discuss from vanguards… New ‘care coordinator’ role: support the GP with their weekly ward round by proactively identifying residents who need attention and updating the GP on their recent history participate in MDT meeting help residents to navigate community and specialist services. 2. New “medication liaison officer” ensuring medication reviews are carried out regularly oversee and attend medication reviews take responsibility for medicines in individual care homes.

Social care institute excellence: SCIE GP services for older people: a guide for care home managers Dec 2013 https://www.scie.org.uk/publications/guides/guide52/gp-roles/relationships.asp Looked at a number of studies and focus groups with managers: themes Need for trust and mutual respect Tackling negative attitudes towards care home staff

Thank you Questions and discussion