Referral of carers
Referral is the process of passing on the information that someone is a carer to an agency or an individual, with a view to offering them some kind of assessment and support or a service adjusted to meet their needs.
It is important to ask the carer what kinds of support they feel they most need. They should be given information abut, and encouraged to consider, types of support which they may not have previously considered. They should feel that their role as a carer is recognised and accepted.
The Harewood practice in Lincoln has had the philosophy of regarding carers as fellow members of the healthcare team, sharing the care of the patient.
Types of referral
The following list of types of support to which carers might be referred is not exhaustive, but does give an indication of what may be available. The carers should be referred directly by the practice, or given the information to enable them to make contact themselves.
Statutory assessment of needs
All carers who are caring regularly and substantially are entitled to a Carer's Assessment from the Local Authority. In order to have access to local services, most Local Authorities will require that carers have an assessment first.
Carers Resource (Harrogate & Craven) have a contract with the local PCT which links specialist carer support officers with the Single Assessment Process Teams, which work at the interface of health and social care, to ensure that carers’ needs are addressed properly through this emerging new system. The Greenwich protocol identifies the requirement to refer carers for an assessment.
Advocacy and/or financial information
This is usually available from the local Carers’ Centre or the Citizens Advice Bureau if there is no local Carers’ Centre. The number of the local Benefits Agency could also be important.
Short breaks from caring
These may be arranged by the Social Services Department or a Carers’ Centre/voluntary agency.
Many Carers’ Centres provide support of this kind. For example, Sefton provides a range of activities as diverse as reflexology and horse riding.
In Reading, the Primary Care Trust has funded a ‘breaks on prescription’ scheme, under which the GP can supply a voucher to carers who need a break. The voucher can be exchanged with Crossroads – Caring for Carers who provide replacement care.
One to one support
This can usually be arranged by the Carers’ Centre, or by providing access to services that may be already available in the practice.
Carers support group
This may be offered by the Carers’ Centre. In some cases such groups are based at the GP practice itself.
Inclusion on a carers’ mailing list
For mail outs of information about support, events and services that may be available locally to carers – often produced by the local Carers’ Centre.
Health support/health checks
This should be available from the practice itself, perhaps in special sessions for carers.
A project in Sedgefield combines a carers’ health check with ‘flu jabs and the opportunity to meet with a support worker from the Carers’ Centre, to look at other ways in which they might be helped. One carer commented “I nearly didn’t come as I didn’t think I could spare the time, but I’m really pleased now that I did...it made me realise that my health is important too”. The pilot has proved to be very successful and the Carers’ Centre is now hopeful of rolling it out to other practices.
Greenwich practices offer well carer health checks and the PCT has produced a carers health check risk assessment action sheet.
In North East Leeds, the PCT has funded two GP practice-based Older People and Carers Support Nurses with, as the name implies, specific responsibility for carers as well as the older patients. They assess need and work with a network of agencies (both statutory and non-statutory) to try to meet it. 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.
A range of leisure or recreational activities to provide a break for carers
It may be important to ensure that carers have the opportunity for some time to themselves, and to participate in activities that are directed at improving the carers’ own physical and mental health. Many activities can be included in this category. For example, Carers’ Centres organised such diverse things as day trips for carers, horse riding, aromatherapy, beauty treatments and so on.
Condition specific information
Carers of people with certain conditions will be dealing with particular issues. For example, those caring for people with learning disabilities often encounter physical aggression and may also provide a high level of personal care. Organisations such as The Alzheimer’s Society have information specifically for carers, helping them understand the course their caring role may take.
Check out our directory of links to useful organisations
Information or training on helping them care safely
Evidence suggests that providing training to carers can improve both health and quality of life outcomes for the person cared for and the carer. Getting up in the night and physical tasks such as lifting, are perceived by carers to cause ill health. Areas that carers may need training in may be moving and handling, first aid, nutrition, managing stress, exercise, relaxation and administering medication. Your local Carers' Centre may provide this training or be able to work with you to do so.
Referring to your local Carers’ Centre
Before referrals to a local Carers’ Centre can become commonplace, a relationship between the Centre and the practice needs to be established. Once this is done, referral will be a quick, uncomplicated process.
If there is not yet communication between the two, ask your local Carers’ Centre to send you information on what support they provide. The Carers’ Centre should also send the same information to the PCT. Also make sure they are aware that you intend to create a carers’ register and begin referring them on and/or providing support at the practice.
Ask the Centre to provide a standard referral form to save the practice a little time and also to provide written responses to a referral, analogous to those received by consultants. This way you will know that the system is working and of use.
One possible extra step, which would provide a lot of information at little investment of time and funding, is to produce a Carer Contact Form asking the carer to give specific detail on their caring role, and what sort of support they require. This could be attached to a referral form that goes to the Carers’ Centre. A copy can be kept in the practice to help keep comprehensive records and develop the best possible support.
York and Selby Carers’ Centre have developed ‘condition specific’ contact cards for distribution to carers via GPs. These list approximately six to nine key organisations relating to that condition, led by the Carers’ Centre.
Carers Resource (Harrogate & Craven) have practice agreements and provide a comprehensive service for their practices. They have demonstrated significant savings of time for other professionals, increased income generated for the carers and a positive impact on carers’ health. Greenwich practices offer well-carer health checks and a carers information pack. One section of the three-part Leeds yellow cards given by the practices to carers gives general information about services for carers.
As a practice nurse in Harrogate put it:
“It’s an excellent service. Patients I have referred in the past year have often come back looking as if a great weight had been lifted off their shoulders. They appreciate having someone focus on them and their needs. It saves me loads of time having someone else to provide emotional support and give the practical ongoing support we can’t provide”.
Referring to other GP practices
This is relevant where the carer is registered at a different practice to that of the cared for, and the carers role is identified by the practice of the cared for.
Carers in Hertfordshire conducted an extensive study in their area, which resulted in the publication of a report highlighting the benefits of efficient carer referral and the potential reduction in hospital admissions as a consequence. We are grateful to Carers in Hertfordshire for providing us with the full report which you can download below:
Identifying and Supporting Carers Through the GP Surgery - What Difference does it make? (137 KB)
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