Recent developments in health
Restructuring of the Health Service
2005/6 has been a time of major re-structuring within health with a reduction in the number of Strategic Health Authorities to nine and of Primary Care Trusts to 152 across the country. There have been major changes in personnel, roles and structures. Some NHS bodies have experienced significant financial pressures. Carers’ Centres have reported much greater difficulties in engaging at all levels related to primary care on carers’ issues. There is a perceived danger of the progress made for carers in primary care and health in general being lost with all the changes.
The New White Paper
This transition in Health comes at a time when the new White Paper on Health and Social Care: 'Our health, our care, our say' (with emphasis on our) is promoting a ‘New Deal for Carers’, comprising:
- An update and extension to the 1999 Strategy for Carers;
- Encouragement to Councils and PCTs to nominate leads for carers services;
- A helpline for carers;
- The provision of local, short-term, home-based respite support for carers; and
- The establishment of an Expert Carers Programme.
Commissioning
Practice based commissioning will give GPs and other members of Primary Health Care teams greater influencing and control over how their local PCTs use resources. Potentially this presents a powerful opportunity to improve support and services for carers. This can apply not only to services commissioned from other parts of the NHS, but from other agencies as well. For example, greater priority could be given to the commissioning of services from the local Carers’ Centre, some of which might be delivered ‘on-site’ at local surgeries.
It is unrealistic to expect practices themselves to be aware of and develop all the available methods for identifying carers and linking them to support. A number of PCTs have developed local protocols to assist practices to do this or have adopted protocols developed by their local Carers’ Centre. Other PCTs have produced local standards against which to assess practices. There is also no point in re-inventing wheels either between PCTs or between practices.
Despite the obvious value of such development work to the NHS, many of the local primary care projects that have been established to do this have received no funding from the NHS, and the funding for some of those which have, has been withdrawn or not renewed. It is very important that funding is planned over a sufficiently long period to enable the schemes to become properly established and to cover all the GP practices.
GP Contract
The new GMS contract for GPs offers 3 points if ‘the practice has a protocol for the identification of carers and a mechanism for referral of carers for Social Services Assessment’. The new PMS contract offers a mechanism for inclusion of carers in contractual requirements.
Although under the new contract, the large majority of practices have claimed the relatively small amount available for establishing a register and referring carers for assessment, there is strong evidence to suggest that the number of carers identified is still only a small proportion of the number of carers out there. Even GP practices with good and well established links to Carers’ Centres are not always managing to identify even all the carers with substantial needs. Identifying some carers may be enough to meet the requirements of the new contract but is not enough to make a real change to those carers’ lives.
If we take a typical five-doctor practice looking after about 8000 patients, about 800 of these will be carers, of which about 270 will be caring for more than 20 hours a week, including about 160 who are caring for more than 50 hours a week – considerably more than a full-time job. These figures should be used as a benchmark by practices to self-assess how well they are doing in identifying carers. This report outlines many methods of identifying carers which should be examined by practices.
The contractual arrangements with GPs present opportunities on a local basis to negotiate and agree with practices about the introduction of initiatives to extend and improve practice-based services for carers. This might include a range of things, such as ‘Well Carers’ clinics or the establishment of dedicated nursing support to patients and their carers.
