GP surgeries – new services for carers
New services provided by the practice
There are a range of new services which practices can consider to meet the health needs of family or unpaid carers.
Additional services for carers may require more financial and/or human resources than only adjusting existing services. However, anything that reduces stress or problems for carers is likely to have knock-on benefits for the practice in the long term. Carers and Carers’ Centres should help you understand the most pressing needs and how to solve them.
1. Health checks or carers clinics
These recognise the potentially harmful effect that an extensive caring commitment can have on the carer, and the desirability of keeping the carer’s health under regular review.
Health conditions perceived by carers to be caused by their caring role are stress/nervous tension, depression, anxiety, back injury and high blood pressure. Caring can also cause a wide range of negative emotions and physical effects such as frustration, sadness, disturbed sleep, physical and emotional exhaustion, anger, loneliness and guilt. (Carers Health Survey) Just over 30% of carers say they have, at some point, wanted to harm the person cared for, largely out of frustration.
Concerns about the future, specifically on what happens to the person if they die and a lack of understanding about the condition of the person they are looking after are other reasons for further anxiety and stress.
It is helpful to include a carers support worker in the surgery with a GP first dealing with the carers’ health needs, and the carers support worker then looking at other needs.
Carers’ surgeries across the country had a very low drop-out or non-attendance rate.
"We realised... that patients needed to be seen individually and would not benefit from group work... [now] any patient who has expressed an interest or a need relating to their caring role is given an appointment in a monthly session. This worked extremely well and now patients are talking to other carers who need similar help."
Drena Black, Practice Manager, The Surgery, High Street, Lowestoft.
"There’s a designated time in which carers’ problems can be dealt with. It saves me contacting all the centres myself – I just get patients to come back. It makes it so much easier for me. Every month I have two or three carers that I’ve referred on to Jan [Jan Wells, the carers support worker from the Aberdeen Carers Centre]."
Dr Pratt, Denburn Health Centre, Aberdeen.
Primary care workers including doctors, community nurses, practice managers and receptionists have reported that the regular presence of the carers’ support worker in the surgery was a valuable reminder to them to refer carers for support.
This is analogous to that of the "expert patient", where understanding, recognising and developing the skills of certain patients in managing their own conditions has been of benefit to themselves and their local practice and hospital.
There are corresponding issues for long-term carers. For example, the government’s National Strategy for Carers stated "the NHS must help carers learn the necessary skills so they can care without risk of injury to themselves". Lifting and handling are the most common causes of problems; various studies have shown that carers are highly susceptible to back strain and other injuries. Again, it is in the interest not only of the carers, but also of the GP practice that this should be prevented.
National schemes are underway to develop the "expert carer" concept but there is no reason why it cannot be developed locally. GP practices offer a potential environment where this can happen and PCTs may be willing to fund such an initiative.
Another approach is to respond to carers’ health issues through other specialists within primary care, particularly among the nursing staff (e.g. diabetic nurses).
In North East Leeds the Primary Care Trust funded two GP practice-based Older People and Carers’ Support Nurses. These specialist nurses have specific responsibility for carers as well as the older patients. They assess needs and work with a network of agencies (both statutory and non-statutory) to try to meet them. The scheme, which started as a pilot project, has been evaluated and found to be of value to patients, carers and the policy objectives of the NHS.
There may be funding issues for this type of initiative, and this should be resolved with close consultation between the practice, PCT and Carers’ Centre. It may be that these services can be included as ‘enhanced services’ or as a specific contracted service to be provided by a PMS practice.
In Leeds, GP practices can earn 200 points on their GMS contracts by consulting patients and carers. Carer consultation is seen as a key part of patient consultation, as carers are patients too.
It has been recognised that the GP practice is often a place with which carers and cared for patients readily identify and are comfortable with, in a way which may not always apply to other locations or agencies. For this reason it is a potentially suitable base for a carers’ support group, or other non-clinical services to carers.
Groups present an opportunity for carers to meet others in similar positions and discuss their issues with somebody who can directly empathise. Such groups are a very effective way of carers providing support to each other, which is in everybody’s interest. They can also help inform the practice on ways in which it might improve its services for the benefit of carers. There are two possible models.
a) Where the practice or health centre provides the premises for the group to meet, but does not participate directly in it. This has the advantage of allowing the carers to feel independent.
b) The practice participates in either part or the whole of the meeting, which has the advantage of facilitating dialogue and mutual understanding between the practice and the carers group. Again, it may be appropriate to seek external funding for such groups.
Mrs A, Brent, cares for her husband following a stroke.
"It’s also the little things that make a difference, particularly when you’re a new carer, like talking to somebody else at the monthly carers’ group and learning how to relax."
Mrs D, Suffolk, cares for her husband who has dementia and prostate cancer. Mr and Mrs D are a retired couple.
"I go to a carers’ group which helps with practical things like checking we’re claiming the right benefits. I have family but there is a limit to what you can ask somebody else to do, so you end up thinking you’re alone. It’s better now I know there are others in the same situation. And I know from the carers’ group how important it is to look after yourself. I can talk about things in the group and it means I don’t always need the doctor to discuss a problem now."
