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Does your GP care about carers?

DSC_0555In my (ahem) forty or so years on the planet, and multiple moves from location to location, I’ve seen a fair few GPs not least because nowadays it can be difficult to see the same one more than once.

Whilst pretty much all of them have done a decent job clinically, there are definitely some who have done a better job in all the other ways that matter. And that goes for my friends and  family too. Like the GP who, knowing my neighbour’s wife had died, took the initiative to come and visit him, just to see how he was coping. Like the GP who, when my friend needed to be admitted to a mental health unit, waited till I arrived at his surgery, and drove  us there himself and saw us into the ward  to make the whole experience less stressful for her.

There have been the ones who have been not so great too. We can all think of times when we’ve gone to the GP, and perhaps because they’re so busy with a backlog of patients in the waiting room, we’ve  felt hurried along and out of the door before we’ve had a chance to really discuss what we wanted to.

The little things go a long way

If you’re a carer, you’ll know all about this. Good GPs and practice staff can make a huge difference and are key to identifying carers. And once they’ve identified carers, they can ensure they get support. Some have flexible appointments, whilst others will do home visits for carers if they really struggle to get out of the house because of their caring role.

Some bring different agencies into the surgery and have support sessions for carers, and have links with their local carers centre or scheme. Others do carers’ health checks and run campaigns to make sure carers get the flu vaccinations they’re entitled to, or signpost them to ways of getting a break.

All this really can make a difference. Identifying carers, and making sure they get the advice and support they need means carers staying mentally and physically well for longer. And in the long run this pays off for GPs too –  people who are healthier ultimately take up less GP time. It makes sense all round.

The Caring About Carers Awards

So if you know of a GP doing a brilliant job, why not recognise this? Carers Trust, in partnership with The Royal College of GPs and Carers UK are looking for the GPs who really are making a difference for carers. You can nominate them for one of this year’s Caring About Carers Awards here.

We’re often told things can’t be done because it costs too much, because it’s too complicated, because everyone’s too busy. But supporting carers doesn’t need to be any of these things. It’s straightforward – identify, listen, involve, signpost for support.  Let’s celebrate the practices out there who are getting it right.

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July 15, 2013 Posted by | Health, Uncategorized | , | 3 Comments

GPs need more incentives to identify carers, not fewer

GP and carerOne of the things we know about carers is that many often don’t recognise themselves as being one — in other words, they don’t realise that they are a carer. They don’t know about available help until quite late on, often after their own health and wellbeing has become badly affected.

Especially for adult carers, we know that the one service they are almost bound to come into contact with is GPs, if not for their own health then for the health of the people they are caring for. So it makes sense that GPS should identify carers and refer them to their local carers organisation for support.

That’s all they really have to do. It’s as straightforward as saying: “Well Mrs McGonigle, you’re doing a brilliant job of looking after your husband but I’m wondering whether there are things we could do to help you too. Did you know there’s a Carers’ Centre that can give you some help? Here’s the number. Why don’t you call them? And I can add you to my list so we can make sure we support you as a carer.” Sounds simple, huh?

Simple as it is, it often just doesn’t happen.  GP surgeries get a payment for having a carers’ register. 10% of the population are carers  — however, even when GPs are being proactive, it’s rare for a practice to have more than 3% of their list registered as carers.

Signs of progress

Across the country, Carers’ Centres and Crossroads schemes work with GPs surgeries to provide them with what they need to support carers better, and real progress has been made. The Government put some cash into this, and Carers Trust has been working with The Royal College of GPs and Carers UK to build better awareness.

For those of you who work for a Carers Trust network partner liaising with GPs surgeries, you can join our Facebook group where staff in similar roles share good ideas and support each other.

But things are changing. The indicator which means GPs get rewarded financially for having a carers register (QOF Management Standard 9 I believe) is being removed. Something similar will stay for carers of people with dementia, and it is suggested that they will also get a health check.

Getting GP practices engaged with carers

This is great, but what about everyone else? There are plans to put the requirement to identify carers in the outcomes indicators for Clinical Commissioning Groups but it’s not clear to me what teeth this will have, or whether practices will just be able to ignore it with impunity.

The current system isn’t great. It’s not well used, and it means GPs can identify a few carers, put them on a list and then do nothing to support them. But at least they do have to come up with some evidence at some point that they have met the outcome and they do it because there’s money attached.

It gives local carers’ organisations the hook they need to get GP practices talking to them. If the CCG outcome indicators have no teeth, that will be a step backwards. We need to know more.

February 8, 2013 Posted by | Health, Uncategorized | , , | 7 Comments

Stuck in the Health and Social Care Bill tea party

Not long ago I did a conference presentation on the Health and Social Care Bill. To make an after-lunch slot a little less soporific I dusted off my White Rabbit and gave the whole session an Alice and Wonderland theme. Curiouser and curiouser, I said, and 3 months on, we’re still stuck. Not going forwards, no going back.  Round and round, consultation after consultation, debate after debate, and still no sign of the tea party being over.  Another cream bun anyone?

Whatever your take on the Health and Social Care Bill, I think the one thing we can all be sure of is that the hiatus that’s occurred within NHS structures isn’t helping anyone.  Don’t get me wrong, we shouldn’t plough ahead with proposals which are likely to make things worse rather than better. Personally I think tweaking the old system with better clinical involvement would have done the job. It wasn’t perfect but it did work. Instead,  what has happened is that  in advance of decisions being made, the system has effectively been dismantled and elements of the new one put in place, with no legislative mandate to do so. Maybe I’m old fashioned but I kinda think you should wait till Parliament has made the decision before you implement it.

I’ve got no problem with involving GPs more in commissioning. Some of my friends are GPs even. But they don’t always have carers right at the top of their agenda. That’s why the Government has worked with us, the Royal College of GPs and Carers UK on a programme to ensure GPs are more carer aware.* Across the country,  Carers Centres and Crossroads schemes work extensively with GPs in their areas, constantly  reinforcing the message about supporting carers.  All GPs need to do is think carer – identify and refer.  But often the carer is sitting there, right in front of them, struggling,  and still it doesn’t occur to them that they could be the lifeline to support.

The other worry I have is that in the shift from the  old NHS structures to the new ones, and the inevitable change in commissioners and staff, all the progress we’ve made on making sure support for carers is prioritised might be lost. The Government has listened to us on this issue, and so have many Primary Care Trust and local authority commissioners, but it’s still not enough and we don’t need any backsliding.

Who knows what’s going to happen now, with more and more health professions rattling their stethoscopes , it could be a while before we know the final shape of the new NHS.  It could get curiouser yet. However, for carers and those they care for, life goes on regardless, whatever the commissioning structures turn out to be.  If we need to start the debate on why we need to support carers all over again, we will. We just shouldn’t have to.

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PS: If you read my blog 2 weeks ago, you’ll see that a carer asked that I mention the Carers Ambassador programme  in England where carers can get involved in their local area  raising awareness of  carers issues. If you’d like to find out more about this, contact the project manager Michael on michael.shann@carersuk.org

February 15, 2012 Posted by | Health, Social Care, Uncategorized | , , , | 1 Comment

GPs can be a lifeline for carers

Note: The following post has been contributed by Moira Fraser, Director of Policy at The Princess Royal Trust for Carers

Trust me, I’m a doctor
 
Well I am, but not a doctor of anything useful. A PhD can come in handy as a doorstop or fly-swat but it’s not much good if anyone’s having a heart attack. It a good job I do know some real ones who I hope would be a damn sight more useful in an emergency.

For carers, a decent GP can be more than just useful. They can be a lifeline.  Of the UK’s 6 million carers, hundreds upon thousands go unrecognised and unnoticed. Many don’t even know they’re a carer themselves. However the one place you can pretty much guarantee a carer will end up fairly regularly is a GP surgery – if not for their own health issues, then for the person they care for.

We’ve worked with the Royal College of General Practitioners (RCGP) for a number of years now, because they get how important this is. If you don’t look after carers, sick people get sicker. It’s as simple as that. And more to the point, the carer gets sick too and then you’ve got two people using NHS resources instead of one.

All this seems obvious. But still it’s often not done. How many times have you been told you can’t have information about how to help someone manage their condition because it’s confidential? How many times has someone said to the doctor “no really, I’m fine” when you know they’re really not fine at all? How many times tried to help but felt you’ve not been listened to? And how often have you needed to go to the doctor yourself but just not been able to – because you can’t get out of the house or you’re just too dog tired?

We’ve just published a new Action Guide for GP practices, jointly with our friends at RCGP, to help GP practices be more carer friendly.  Just listen. Think about depression. Think about family finances. Signpost to services. Plan for emergencies.

Not hard, not complicated.

Just needs GPs to take carers seriously and do it, working with their local Carers Centre.
Trust me.
 
Read our guide here

November 17, 2011 Posted by | Health | , | 3 Comments

Carers show the true face of caring

A few years ago, Karen gave up work to care for her husband full time. She wanted to work part-time and care but her

Young carer helping his brother

employer was not willing to consider reduced hours. Plus, health and social services calculated that it would cost £160k p/a to provide a care package to meet all of his needs. The cheaper option was to leave the care to her and provide £5k worth of support.

Karen’s husband has a degenerative condition which does not directly cause early death. She pointed out that he could live for another 28 years but that there would be no chance she could carry on that long. She feels that she is being run into the ground and exists to provide care.

For about 90 minutes today, Karen shared her story with Rory Stewart MP, Peter Aldous MP, Laura Sandys MP, Cathy Jamieson MP, Andrew Bridgen MP, Stephen Mosley MP, Jonathan Lord MP and Tracey Couch MP.

James (aged 19) and Samuel (aged 15) were also there speaking to these MPs. Both care for their mothers and have done so for many years. Their message was simple:

  • GPs need to think about who is looking after their patient at home
  • schools have to realise that pupils can be young carers which affects their school work
  • local young carers’ projects can provide vital support

These were young men who were speaking matter of factly about what they do, the impact on their own lives and what more should be done. It always strikes me how mature young carers can be when discussing their situation. Afterwards, we walked around London to see Buckingham Palace and Trafalgar Square, and they  talked about their interests and futures. This should be a time of choices for both.

Karen didn’t seem to have many choices; the map for her life had already been drawn. Her story illustrates why many carers feel taken advantage of and taken for granted.

The galling thing is that Karen could be considered a lucky carer as she might get a personal budget of £500 this year as a result of the Government’s £400m injection into the NHS for carers. Very few carers get a personal budget (fewer than 50,000 in 08/09) and if they do it is usually for approximately £250. So Karen could nearly consider herself a model of how the extra money is providing extra support. But as she pointed out, her £500 will still only provide one hour off every fortnight.

This is not the change that carers need. This can only just be the start or we will leave James and Samuel with no choices, and no chance.

Take care

Gordon

PS: Carers need continued support. Don’t forget to tune-in to BBC Lifeline’s appeal for carers on BBC One on June 19th at 4:45 pm (if you are in Scotland, Wales, Northern Ireland) and 5:15 (if in Scotland). Please do spread the word.

June 14, 2011 Posted by | Benefits, breaks for carers, Carers Week 2009, Relationships, Young carers | , , , , , , , | 3 Comments

An Essential Triangle of Care

Note: The following post has been contributed by Carole Cochrane, the Chief Executive of The Princess Royal Trust for Carers

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Wednesday 28th July was another hot day in London (well it was for northern based lass). And like many of my London working days it was crammed with various meetings.

The day started with a breakfast review meeting with The Trust’s Director of Fundraising before we both went off to meet with someone who had recently made a significant donation to The Trust (always good to thank in person).

As I say it was a hot day and by the afternoon I was already feeling pretty tired and dishevelled and I had to change into a new set of clothes. Feeling a bit more like a Chief Executive, I headed off to my last appointment of the day which was to launch the Triangle of Care report at the House of Lords.

Tony Baldry MP, Co-Chair of the APPG and a real supporter of carers, was really the person launching the report. I was asked to speak and although I had some points prepared, after talking to carers there I felt that I wanted to speak as a sister of someone with a ‘severe and enduring’ mental health issue.

I talk to so many carers of someone with a mental health issue, who are often worn down with caring and fighting to get good services and I felt that I needed to speak for my parents, my sister and all those other carers who don’t get the chance to do so.

I know only too well the impact my sister’s illness has had on our family unit and in particular on the health of my elderly parents, who are still the ones that pick up the pieces when my sister is ill and again when she is discharged back into the community, sorting out a flat, furnishing etc.

The Triangle of Care report attempts to bring together the carer; the cared for and the professional and get them all working as partners. So many carers tell me they feel invisible when care packages are being put together but are all too often the ones that have to implement and manage the care.

The essence of the document is to clearly identify the six key elements
required to achieve better collaboration and partnership with carers, with good practice examples and resources.

1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter.
2. Staff are ‘carer aware’ and trained in carer engagement strategies.
3. Policy and practice protocols re confidentiality and sharing information are in place.
4. Defined post(s) responsible for carers are in place.
5. A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway.
6. A range of carer support services is available.

I had a really enjoyable time at the event and spoke to some wonderful carers who I know are hoping that the Triangle of Care becomes everyday practice so their loved ones get the services they so richly deserve.

P.S: had a recent text from my sister who tells me she is really happy – it has been over 25 years since we have heard those words – so I know things are getting better for her and my parents and that is what I am sure those parents that spoke to me on the night long to hear.

August 5, 2010 Posted by | Carers Strategy, Health, Mental Health | , , , , , , , , , | 4 Comments

Carers and the Big Society

Note: This post is from our guest blogger Tony Baldry MP who is Co-Chair of the All Party Parliamentary Group for Carers. Tony Baldry MP made a speech at the meeting of The Princess Royal Trust for Carers held in the House of Commons on Wednesday, 28th July 2010.
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Last week, the Prime Minister repeated his commitment to the Big Society making it clear that its’ success will depend “on the daily decisions of millions of people – on them giving their time, effort, even money, to causes around them”. My whole political life has been predated on this same principle.

However, I am concerned at a potential and unintended conflict between the Coalition Government’s very understandable desire on the one hand to promote the Big Society and the need to cut the budget deficit.

In my constituency in Banbury we have the North and West Oxfordshire Carers’ Centre, member of The Princess Royal Trust for Carers and has been successfully running now for nearly two decades.

Such has been the dedication and commitment of the volunteers that the centre has won the Queen’s Award – one of very few such awards in Oxfordshire. The Banbury Carers’ Centre like the Oxford and South Oxfordshire Carers’ Centres are comprised of a mixture of experienced volunteers and some paid staff, enjoying the financial support of the local community.

They help train carers. They provide outreach services for carers. They provide a place where carers and different types of carers can come and meet, share experiences, unwind and support each other.

As we all know, carers come in many kinds from young carers to very elderly spouses still looking after a much loved husband or wife.

In undertaking this valuable work, for many years the Banbury Carers’ Centre has received funds from Oxfordshire County Council to deliver specific agreed services to carers. The reasons the County Council was procuring these services from Carers’ Centres are exactly the reasons set out by the Prime Minister in support of “the Big Society”; Carers’ Centres and their volunteers are exactly the people who are making a difference, are in contact with other carers and are in the best position to understand, articulate and meet carers’ needs. They are full of people who come together and work together to affect social change and to improve life for carers.

As far as I am aware there has never been a suggestion that the Banbury Carers’ Centre or the other Oxfordshire carers’ centres have failed to meet the objectives with which they have agreed with the County Council. However, the Council has to make savings in their budget.

They are proposing withdrawing their funding from the carers’ centres in Oxfordshire and replacing that service by a telephone call centre, almost certainly run from outside of the county to which carers will be able to call.

Part of the justification of this move, in addition to the need to save money, is an assertion that it will help them reach more carers. However, there doesn’t appear to have been any or any real discussion with the existing Carers’ Centres as to the number of carers that they are already reaching.

I would suggest the issue here is that many people who are carers simply don’t recognise themselves as being carers and if they don’t recognise themselves as being carers, they are not likely to ring a carers’ telephone hotline.

We need a collective effort to help carers voluntarily register themselves as carers so that they are recognised as being carers by GPs or by schools if they are young carers. This requires a sustained campaign in GPs surgeries, in the schools, and in the media to make people ask the question “are you a carer?”

I suspect that for many years GPs haven’t been asking the question of whether someone is a carer, because there has been very little that they could do to support them. However, now that PCTs have funds to support respite care, GPs are in a position to refer carers for respite care and short holiday breaks and for that reason alone, one would hope that every GP practice would know which of their registered patients are also carers.

I think the reality is that for many years central government has used local government to support a whole range of social interventions. Money for carers’ breaks is given in part to PCTs and given in part to local Councils. However, if local government is obliged to save money, they understandably start by reducing funding for those organisations for which they have no immediate responsibility.

However, there are a very large number of active citizens undertaking constructive voluntary work within our community who to a certain extent depend on some funding from local government. An alternative, of course is to allow organisations such as the Banbury Carers’ Centre to bid direct to central government to provide carers’ services.

Here we appear to be bedevilled that Oxfordshire County Council has decided to bundle up all its carers’ contracts into a single contract, thus bringing it within the parameters of the EU procurement directives and requiring compulsory tendering. This makes it much more difficult for local voluntary organisations to bid and appears to run completely counter to the desire for localism and the Big Society.

I think we all have to accept that these are particularly difficult and unusual times. No peace time government has had to tackle a similar financial deficit. We need to develop the Big Society. We need to see how we can best reconcile these two policy objectives. However, to start with we have to recognise and acknowledge that there are some real tensions that need to be worked through.

Tony Baldry MP
House of Commons

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July 28, 2010 Posted by | Budget, Carers Strategy, Conservatives, Liberal Democrats | , , , , , , , , , , | 8 Comments

“Out of Hospital” Report Calls for Carer Involvement in Discharge Planning

Note: The following blog post has been contributed by Beryl Cross who is the Development Manager (South East) for the Princess Royal Trust for Carers.

Today is the launch day for The Princess Royal Trust for Carers “Out of Hospital” report and we are calling for the NHS to take practical steps to work together with carers as equal partners when planning for the discharge of patients from hospital.

The “Out of Hospital” project included partnership work between carers, Carers’ Centres and hospitals in Barnet and in Swindon. This afternoon carers, carers’ workers and NHS workers from Swindon and Barnet will be at the launch to share the practical tips that they found worked to get everyone acting together to benefit patients and carers and avoid readmissions to hospital.

I’m hoping the launch will inspire those NHS workers who attend to develop their partnership with carers and in turn help them in changing hospital systems and culture. We’ve already received messages of support from the Royal College of GPs and other NHS bodies so that’s a really positive start.

Have a look at the key messages from the report and it would be great if you could share them with other carers, carers’ workers and NHS planners and staff that you know.

I will be back soon to let you know how the launch went, including what the carer presenting at the launch had to say.

All the best,

Beryl

July 21, 2010 Posted by | Health | , , , , , , | 3 Comments