Dr Sachin Gupta

Supporting Carers in General
Practice & role of RCGP GP
Champions for carers
Dr Sachin Gupta
GP, Welwyn Garden City
RCGP GP Champion for Carers, East of England
Macmillan GP
• Why GPs & Commissioners should support
• How GPs can support carers- simple steps
• Role of RCGP Champions for carers
Win-win situation
• Supporting carers in general practice is a win win
situation for everyone.
For carers
- Improves their wellbeing
- Prevents illnesses in carers,
- Improves their ability to provide better care
For GPs & NHS
Reduction in referrals to
-social services for professional care at home
Win-win situation
Reduction in referrals for
- NH/RH placements- study in Herts suggest 17%
RH admissions due to carer breakdown
- Hospital admissions
- Improves health and wellbeing of carers & person
cared for
Study tracked people aged over 75 years and found
that 20% of people needing care were admitted
to hospital because of breakdown of a single
. Admissions, needs and outcomes’; Mittelman M et al (1996), Brodaty H et al (1997); Dröes, R et al (2006)
Examples of good practices in East of
• Herts Valley CCG project- every practice has a Carers
Champion funded by CCG
• Carer friendly community project (Stevenage)
- will demonstrate the effectiveness of certain interventions
to be evidenced
• Carer friendly hospital (Lister Hospital)
to implement interventions at specific 'trigger points' in the
caring journey which will delay admission to residential care
and/or escalation to acute medical services
• Carers break prescription service (Cambridge)
Reasons for Carer friendly projects
1) Significant numbers of permanent residential
care admissions are the result of carer
- A previous study of Hertfordshire pathways into residential
care has indicated that 17% of permanent residential care
admissions are due to carer breakdown.
2 Low level support to carers has been proven to
have an impact on delaying residential care
admissions and hospital admissionsInternational random controlled trials have shown that
early intervention to support carers results in significant
delays in admission to residential care, and an up to 28%
reduction in admission in comparison to control groups.
Source: Bebbington et al (2001), ‘Care Homes for Older
People: Volume 2. Admissions, needs and outcomes’;
Mittelman M et al (1996), Brodaty H et al (1997); Dröes,
R et al (2006)
3) Carers make a huge and increasing contribution in
terms of the care they provide to their partners,
relatives and friends-It would cost the state £2.1bn if it were
to pay for the hours of work carers do to support their cared for in
• Herts population of those with aged 65+ will rise from 166,700 in
2009 to 251,800 in 2030. Currently, there are approximately
138,000 carers in Hertfordshire. In 2017, there will be a ‘tipping
point’ for care when the numbers of older people needing care will
outstrip the numbers of working age family members currently
available to meet that demand. The number of carers nationally is
set to increase from 6 million today to 9 million by 2037.
Expected benefits
• Carers have a life outside caring (breaks to support
other outcomes)
• Carers stay fit/healthy and are safe
• Carers feel respected as carers, as partners in care
• Reduction of £50,000 in permanent residential care
costs by delaying residential care admissions
through the carer friendly community and carer
friendly hospital
Benefits continued..
If the benefits of Phase One are realised, then
following benefit is expected to accrue from
phase two over four years:
- Reduction of £3m in permanent residential care costs by
delaying residential care admissions through the roll out of
the carer friendly community and carer friendly hospital
-will result in delaying 8 residential care admissions by one
Effect of prescription break
• Carers risk of depression before and after a
PCT funded break, as measured by SF12
screening (based on 137 pre- and postsupport questionnaires
What can GP’s do
• Develop practice action plan to identify and
support carers
- Use RCGP & PRTC action guide for GP’s and their
practice staff to support carers
- Five Keys ways for GPs and primary care team to
support carers
a) Listen
b) Think of depression
c) Ask about finances
d) Signpost to services
e) Plan for emergencies
• Identify a Carers Lead
• Identify carers proactively
• Screen carers for depression annually, invite
carers for flu vaccination
• Signpost carers to help them to perform their
caring role
• Refer carers for social services carers
• Ensure carers have an emergency plan in
What can CCGs do ?
- Raise profile of carers at all levels
- Inclusion of carers into CQUINS
- Carers representation at CCG Stakeholders
- Carers engagement with service redesign and identification of local
- Work with Local authorities, council and other stakeholders to
support and develop services for carers
eg Herts Valley CCG project to support carers, Carer friendly
in E&N Herts
Role of the GP Champion
“to champion, advise
and support carers
initiatives, events and
commissioning within
each region”
• 10 Regions
• Based on previous
Strategic Health
Authority areas??
Supporting Carers
Carers Leads
Patient related
Primary Healthcare
Primary Care Trusts
Practice Teams
Local Councils
GP Liaison Staff
Voluntary Sector
GP Champions
Expert Practitioners
Carer Ambassadors
Work done so far..
• Raised awareness in primary health care professionals
- Practice visits, practice managers forum
- Attending Locality and CCG events/ meetings
• Trained GPs/ GP Registrars & nurses to identify and support carers
• Worked in partnership with CCGs & commissioners on local initiatives
• Proactively supported carers initiatives
• Collected and shared examples of good practice
• Promoted use of ‘action guide’
• Assisted in development of RCGP commissioning guidelines
• Developed relationships with other stakeholders
• Advised & assisted on local projects eg carer friendly projects in Herts
Questions & Answers

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