The Richmond and Kingston Clinical Commissioning Group led a facilitated discussion with carers at the recent Carers Wellbeing Day in York House, Twickenham. Seventy-one carers attended the event itself with eight of those attending the facilitated discussion, which was around the topic What make a carer-friendly GP practice?. The major points raised during the discussion were as follows:
Regarding local services, there was very positive feedback about the Nightingale Service (also offers telephone support, which can help carers when they feel unsure about what to do); the Dementia services at Barnes Hospital (who link the carer in with support for dementia), and the caring café in Barnes, which is an opportunity for carers to get together while the cared-for is looked after. It was also mentioned that GPs are trusted by local people and are therefore felt to be effective for signposting to services etc.
The question was raised as to how a patient/carer can align their list of medicines when they are out of sync. This is possible for some prescriptions, which can be aligned via batch prescribing. However, it is not possible for all medicines such as creams. The patient/carer should ask their GP to align them or include a note requesting this with their prescription.
Confidentiality and consent
Carers sought clarity around what input they can have as a carer in the patient’s consultation. Discussion followed on the challenges of supporting a person when they are deemed as having mental capacity but are not cooperating/communicating with the carer to enable support to be put in place. It was suggested, where possible, to have the carer and patient in the consultation with the GP and for the GP to discuss consent. If the patient agrees, they can talk through the areas a carer can be involved in and a simple agreement drawn up and signed by carer, patient and GP. This would allow an alert to be placed on the patient record about consent. It was noted that this approach is taken proactively by some GPs and is something that could be considered by those who don’t work this way currently.
Carers voiced frustrations around not being able to book appointments on behalf of the cared-for, despite not seeking to discuss information about them, which creates barriers to accessing services when the cared for will not/cannot book it for themselves. Carers’ understanding, experiences and advice regarding patient’s reactions/behaviour patterns is not taken into consideration by service providers/professionals. It was felt there is more support and ease of access for carers of patients with dementia, as opposed to those of patients with learning disabilities or mental health conditions where the patient is challenging and not engaging with services.
It was noted that if an individual has capacity but refuses to engage with services/the carer this can’t be forced, and that there are times when this might become a safeguarding issue for either the carer or the patient. There is an opportunity for the GP or service to work with the individual to understand why they are refusing support, possibly previous bad experiences.
Support for carers
When looking after very challenging individuals with mental capacity carers need support to negotiate with the person for whom they care. The group was not able to identify where a carer would go for this support, possibly advocacy services or the carers centre. It was felt there are lots of ‘soft’ support options out there.
Carers were advised they can ask for a GP appointment without their cared-for to talk through their concerns about that individual and caring for them. Carers are encouraged to write a list of what they want to cover before attending the appointment. The GP can flag on their record that they are a carer, but noted that carers will often not think about their own health, focusing instead on how they help the person for whom they care.
Impact on carers own health
Carers wanted more information on power of attorney and advanced care planning for carers available in practices, and some viewed noticeboards as helpful. It was mentioned that all carers should have a carers assessment to assess what support/information they require, but not all carers were aware of this. Social prescribing could also help to identify carers and link GP practices to local support services.The idea that GP reception staff should signpost patients/carers to local support services was viewed positively and it was agreed that there should be consistent approach as to how GP practices support carers in Richmond (particularly with regards to information available at crisis point), though managing this across independent practices may be a challenge.
Training/support for GPs
It was suggested that discussion/interviews with carers should be recorded and included in education/training sessions for GPs and practice staff. The CCG supported the idea of providing opportunities for carers to share their experience with GPs and other health and care professionals.
Source: Richmond and Kingston Clinical Commissioning Group