1. ECHO 3 Working with GPs

2. 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

3. 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…

4. https://britishgeriatricssociety. wordpress

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

6. 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.

7. 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.

8. 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.

9. 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

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

11. NHS England enhanced health in care homes (ECHC) framework Sept 2016
6 vanguards across England with good examples of care including effective working with GPs

12. 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.

13. Social care institute excellence: SCIE
GP services for older people: a guide for care home managers Dec 2013
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

14. Thank you
Questions and discussion