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At the heart of general practice since 1960

Keeping up with the octogenarians

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How do you solve a problem like Maria? Or Albert… or Ethel… or any other 85-year-old person who is part of the fastest-growing cohort of the population?

The Government has invested additional millions of pounds in the NHS, but this is barely scratching the surface when you factor in the increasing life expectancy and comorbidity of the population. At least a third of babies born today are predicted to reach the age of 100.

It seems ‘frail’ is the latest politically correct term, supposedly less offensive than ‘old’. Try telling that to an 85-year-old; regardless of their functional status, they will not identify themselves as frail.

GP training is languishing behind this fast-moving NHS train

But I recently attended a frailty conference in an effort to furnish myself with the tools to manage this ticking time bomb. The term Complex Geriatric Assessment (CGA) was mentioned at least 10 times – the panacea to manage the elderly population. The elderly arrive in the emergency department and are CGAd. They attend an acute admissions unit and are CGAd. They are seen in a clinic and are CGAd. I was desperate to learn these magical skills so I, too, could CGA all my elderly patients. Then I learned it was nothing more than a psychological, social, functional and medical assessment.

I felt shortchanged because it was all so bloody obvious. It’s not as if for the past 15 years of home visits, I was ignoring the loose rugs, the cognitive impairment and the social isolation.

This is the bread and butter of general practice and, for once, GPs ARE best placed to manage these patients. No other doctor is able to manage risk and uncertainty – with a healthy dose of pragmatism – as well as an experienced GP, which is why we are ideally positioned to respond to the needs of the frail elderly.

And in our brave new world of vanguards and multispecialty community providers, it is highly likely that although large chunks of the traditional GP role will be siphoned off to nurses, pharmacists, physiotherapists and paramedics, GPs will still be left dealing with the complex ethical and medical decisions on comorbidity and end-of-life care.

But there are three problems with this. First, we don’t have time for a two-hour CGA and if we are not given enough space to do this the elderly will continue to get stuck in the cracks between primary, secondary and social care. Second, is the new generation of GPs ready for this? Somehow I don’t think so. GP training is languishing behind this fast-moving NHS train and continues to propel a conveyer belt of Dr Finlay-style GPs who are jacks of all trades and see everything from verrucas to psychosis. It is not preparing trainees for the new models of care where GPs will become community geriatricians. Lastly, the reductionist approach to our role will eventually lead to subspecialties in general practice, and we will say goodbye to the last GP generalist. RIP the family doctor.

Dr Shaba Nabi is a GP trainer in Bristol

 

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Readers' comments (9)

  • Not sure I agree. Current GP training seems quite suitable for "complex geriatrics" to me.

    Plus "old" and "frail" are really not synonyms!

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  • Three years of training to become a GP is a joke. Its like training an orthopaedic surgeon for three years then unleashing them as consultants onto patients. No wonder so many GPs end up investigated by the GMC. Criminal.

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  • the baby boomers are generally the happiest group in society that I see. The young, middle aged, and very old seem riddled with anxiety.

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  • An amazing distortion of statistics.

    Officially the UK population in 2005 was 60,210,012 and in 2015 was 64,715,810 (in 2016 it is projected to reach 65,111,143).

    Does Dr Nabi suggest that the extra activity crippling the NHS is due to a dramatic expansion of the population's lifespan and has nothing to do with mass immigration?

    What next? Euthanasia on a grand scale to make space for the young, robust and illness-free newcomers?

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  • Anonymous | GP Partner17 Jun 2016 3:34pm

    Unless you can justify that the growth was disproportionately made up of net immigration, and not as a result of a post-economic crash baby-bonanza, then the raw population data is pretty meaningless.

    I think I can guess which way you view Brexit though?

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  • Community geriatricians are best placed to manage these patients not GPs.They have the necessary generalist experience in hospital medicine managing complex co-morbities.Also remember alot of these patients will be in care homes who have a habit of calling GPs for anything and everything just to cover their backs.Do you have the time to make those visits?Do you have the patience to deal with irascible relatives who demand admission and are all too ready to make a complaint if they disagree.God forbid if they happen to die!!Nah....these patients are best left to the geriatricians.

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  • Looking after our old and frail in the community is our duty as GPs, AKA community/primary care consultants. However, we need time, staff and moneys to do a good job. This more-for-less and GP ideally-placed-for no extra cash has to stop. The guilt-tripping for wanting a good life for our hard work and expertise also has to stop. Enough is enough.

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  • Basically the friends and family test... How would you like your grandma grandad treating... The difficulty is that the care needs to be multidisciplinary ... Social OT Voluntary support physio ... Psych geriatricians. Etc.
    Without readily accessible and proactive support of these
    The conductor of the orchestra... The so called "named responsible GP..." is really going to be stuck ...

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  • Some elderly are actually very healthy
    No medications, no problems... Enjoying life

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