A key national policy network representing adult social care and carers’ groups across England is championing CLEAR recommendations aimed at reducing pressure on GP practices by providing better support for carers.
The recommendations from the CLEAR Proactive Care project in East Warrington have been endorsed by the Association of Directors of Adult Social Services Carers’ Network as a “cost-effective way for carer support to be delivered directly to carers through primary care while reducing pressure on GP appointments.”
The project was commissioned by NHS England with a remit to develop new ways of working to help GP practices and other health and social care services meet an unprecedented demand for care from people living with frailty.
After interviewing more than 50 people from a broad range of services and carrying out a detailed analysis of data relating to 31,020 frailty patients, the CLEAR team found that a number of barriers to adequately identifying and supporting carers was a critical factor in the ever-increasing strain on primary and secondary care services.
Carers were struggling to cope but were unable to access timely support which led to carer arrangements breaking down. GPs reported seeing carers with their own health problems, while the health of those they were caring for deteriorated. Carer breakdown was found to be one of the main reasons for emergency department (ED) attendance and emergency admission for severely frail patients.
Although reception staff had good knowledge of the practices’ patients and carers, key members of the primary care team were unaware of important information about local carer support options and how to access them. Systems for identifying and coding informal carers were inconsistent across the primary care network’s three practices.
Improving identification of and support for carers was a key recommendation resulting from the project.
The CLEAR team proposed creating a carers’ co-ordinator as part of a new specialist ‘ageing well’ team supporting primary care to provide personalised, proactive care for patients with mild to moderate frailty. Reception staff could be trained to systematically identify carers when they first contacted the practice on behalf of the patient and there could be streamlined coding of carers and a formal carers’ register.
An alert system could be in place so that the whole practice team could see that someone was a carer when accessing their notes and all practices could proactively identify young and adult carers.
As part of a system-wide shift from reactive to proactive care, carers could be given the help needed to navigate solutions for themselves and access support earlier.
The CLEAR team forecast that, if all its recommendations were implemented, the workload on GP practices would ease and staff morale and retention improve. Annual savings of £144,339 could be achieved based on a 50% reduction in GP appointments for moderately frail patients, a 30% reduction for mildly frail patients and a 30% reduction in ED attendances and associated first night admission costs.
The recommendations were tabled at a meeting of the ADASS Carers’ Network where it was agreed that they should be promoted at a national level as the project provided evidence that investment in specific carer support could ease the burden on GP practices.
Claire Brewster, who led delivery of the CLEAR proactive care programme, said:
“It’s heartening to see our recommendations from East Warrington being recognised and promoted at a national level.”
“Supporting carers to care is a national priority for NHS England which recognises that they don’t always get the recognition and support they need. Our project demonstrates that investment in carer support has major benefits not just for patients, their carers and general practice but also for the wider health and social care system.”
Read more about the CLEAR Proactive Care Project at East Warrington.