Background to

GP Carer Awareness Project in Surrey

1. Overall vision and context

Vision from the National Carers Strategy 2008: “Carers will be supported to stay mentally and physically well and be treated with dignity.”

The important part that primary care plays in providing help and support to carers was a consistent theme from carers in discussions about the national Carers Strategy. Primary care is very often the first point of contact with services and carers have made it clear that such support is variable.

Significantly, the operating framework for the NHS, which sets out the

specific business and financial arrangement for the NHS in any given year, in 2008/09 made, for the first time, specific references to supporting carers. It sets out an expectation that:

“PCTs should aim to create a more personalised service that provides support for carers […] by recognising their need for breaks from caring.”

In November 2010 the Government published ‘Recognised, valued and supported: Next Steps for the Carers’ Strategy’ which focuses on improving health and social care support for carers for example by promoting early self-identification, personalised support and maintenance of carers’ health.

The operating framework for the NHS in 2012 – 2013 states that:

“Carers play a vital role in our system and must receive help and support from local organisations.” It follows this up by setting out the requirement for PCT clusters to work “with local authorities and voluntary groups to support carers, where possible using direct payments or personal budgets.” There is also a need to identify how much is spent on carers’ breaks and how many breaks should be available.

A key provision of the new “Care & Support Bill” is that the Government expects the NHS to work with local authority partners and local care organisations in the interests of carers. From April 2013, the NHS Commissioning Board and Clinical Commissioning Groups (CCGs) are responsible for working with local partners to ensure that all carers are identified and appropriately supported.

Between 2011 and 2015 the Government is providing an additional £400 million to commissioning bodies as part of its Carers’ Strategy to improve support for carers. The funding is not ring-fenced however, and so local Clinical Commissioning Groups can decide how this is spent.

As part of the restructuring of the NHS there has been the establishment of Health and Wellbeing Boards to provide local systems leadership across health, social care and public health.

In September 2006, the Princess Royal Trust for Carers (PRTC) and the Royal College of General Practitioners (RCGP) launched a two-year partnership designed to improve knowledge and understanding of carers and carers’ issues among primary care professionals. This led to a good practice guide, highlighting the needs of carers and carers’ health, launched in October 2007, and a further action guide for GPs and their teams published in summer 2008. A revised second edition of this best practice guide was published in 2011.

The benefits to carers of such a partnership are self-evident in terms of better support being offered by GPs to carers in their caring role and for their own health needs. In addition, a partnership such as this signals the direction of travel, which will ensure closer working between the third sector and health and social care organisations to achieve the best possible outcomes for the carer.

2. Expanded service

A successful pilot project was run in Guildford and Waverley for several years, managed by Waverley Carers Support. The expanded GP Carers Recognition service has been managed by Action for Carers Surrey since 2010, with funding from the Joint Carers Commissioning group. The service changed its name to GP Carer Awareness in 2012 to reflect the focus of the work in surgeries and the need for discussion with GPs and other health professionals of the measures that can be taken to give a sharper focus to the distinct needs of carers.

The 3 GP Carer Awareness Advisers, based in South West, North West and South East Surrey, provide a service across all GP surgeries in the county, using the model developed from the pilot work in Guildford and Waverley.

They assist in the identification of carers, provide information and support with regards to the registration process, and help promote local carers support schemes.They raise awareness with all health care professionals of the possible impact that caring can have on a person including the physical, emotional and financial effects.

3. Objectives

The overall key objective of this project is to improve the health outcomes and reduce health inequalities for carers .

The specific objectives are:

  • To encourage and enable GP practices & Clinical Commissioning groups in Surrey to identify and support their patients who have a caring role.
  • To implement GP Carers registration, ensuring both existing and new carers are identified as part of this process.
  • To signpost and refer carers on to appropriate services and support, in particular to social care for a carers needs assessment or to the local carers support organisations for further information and advice.
  • To ensure that GPs have an awareness, and better knowledge of the needs of carers; that carers' expertise and competence is acknowledged, and a willingness is demonstrated to regard them as partners in the caring process.
  • To implement the RCGP/PRTC (now the Carers Trust following the merger with Crossroads Care) guidance to encourage carer friendly practices

4. Background

In Surrey there are about 108,400 adults carers and 14,000 young carers (figures taken from 2011 census). There were 29,500 carers in Surrey identified in the 2011 Census as providing over 20 hours care a week. Of these, 18,500 were providing 50 hours a week or more. The survey also shows 76,054 carers of working age ( 25 – 64) many of whom may be juggling work and caring

Carers in Surrey save the nation an estimated £1.17 Billion a year. (University of Leeds 2007).

National Carers Strategy, the White Paper “Our Health Our Care Our Say”, the Operating Framework for the NHS in England, Guidance on Joint Strategic Needs Assessment all require a coordinated approach by Surrey County Council and NHS Surrey in commissioning services for carers.

The national protocol “Putting People First” builds on the White Paper and outlines a national agreement to develop the personalisation agenda, provide leadership to enable communities to support themselves and improve information and advice for “self-funders”.

NHS Surrey is working closely with Surrey County Council to implement the National Carers Strategy.

5. Local and National Evidence

One in eight of the population in the UK is unpaid carers. Over a million of those carers care for more than 50 hours a week – which is equivalent to the number of staff employed by the NHS. The NHS benefits greatly from the contribution made by these carers, as they help the NHS understand the needs of the person they care for as well as providing vital care in the home that many patients rely on.

3 out of 5 of us will become carers at some point in our lives. By 2037 Carers UK estimate that there will be 9 million carers in the UK.

It is estimated that carers save the government £87 Billion annually (£1.2 Billion for Surrey). This figure is taken from new research undertaken by the University of Leeds and published September 2007.

Approximately 10% of patients are likely to be carers. Of these about a third are likely to be caring for more than 20 hours per week, and a fifth caring for more than 50 hours per week. Evidence shows that for many of them, it is highly likely that their own health needs are being overlooked, mainly because they are short of time and their focus is often exclusively on the needs of the cared for person. They are an ‘at risk’ group in health terms because of their vulnerability to both physical ailments such as back strain caused by lifting, and stress-related conditions. They frequently do not get enough sleep or rest. Many are elderly themselves. For these reasons alone, they should be regarded as a disadvantaged and high priority group.

Research by Carers UK shows that it takes 1 year for 65% of carers to identify themselves as carers and up to 5 years for the remaining 35%. These are the hidden carers.

The partners to the pilot project ran a benchmarking exercise to ascertain the number of carers registered with their GPs across Surrey. Outside of the pilot area only 7 surgeries responded to this request for information. Within the pilot area, there was a 100% response rate with 1,958 carers having registered with their GP’s- a further 509 on the previous year’s evaluation. Over the two years that the project has been running across the county, the number of carers registered as such with their GP has risen from 6,247 in January 2011 to 13,564 in January 2013 - statistics demonstrating again the impact that the project has had on GP registrations and referral on to other support. However this is still a long way off from Carers UK estimation that at any given time 10% of a surgery’s list should be made up of carers.

There are other compelling reasons why primary health care professionals should prioritise the health of carers. The carers are playing a vital role which, if anything happens to them, will have to be provided by the statutory services in some form. Carers not only provide care but also have an important role in monitoring the condition of the person cared for, which is key to primary health care providers.

The health and welfare of the patient and the carer are closely linked. Deterioration in one will have an adverse effect on the other. If this gets to the point where the continuation of the caring relationship is under threat, then there is a major problem for the health and social care professionals to respond to. It is therefore only common sense, as well as cost-effective and economic sense to try, as far as possible, to look after the needs of the carer. By doing so, the GP practice can anticipate and prevent crises for both the carer and the patient.

6. Identification and Signposting by Primary Care

Identification and signposting of carers involves establishing systems within practices to enable them to identify carers and refer to appropriate agencies such as social care or local carers support.

Without a structured, systematic way of identifying carers and patients who have a carer, it is almost impossible to implement a policy of providing support to carers. Setting up such a system and keeping it up to date adds real value to the services that practices provide.

Coding a patient’s medical notes that they are a carer allows practices to monitor how many carers they have identified and are providing support to. However, 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. In the baseline survey conducted in 2005 only 3.3% of carers were registered with their GP’s in the pilot area. The most recent figures show that this has increased to 11.1% of carers across the whole of Surrey. There are still many carers to be identified and support that could be given to make a real change to these carers’ lives.

Structured recognition helps the carer to feel that their contribution is acknowledged and valued, and that they are part of a team providing health care to the person being cared for. This in itself is likely to have a positive effect on the way carers approach the practice and use its resources. It will enable the practice to monitor the caring situation more effectively, and identify problems at an earlier stage, and to provide both appropriate information and other support to the carer and the cared for person. It will also enable the practice to communicate this information to other agencies and professionals, such as hospitals, who might be able to prioritise and adapt assistance or services given to carers.