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GPs should review elderly patients six-weeks after discharge, says new report

GPs should receive hospital discharge summaries for all elderly patients and should review their care arrangements six-weeks after they are discharged, a new report suggests.

The report from the independent commission on improving dignity of care for elderly people suggests GPs should check whether care arrangements put in place when the patient was discharged are still appropriate.

Commissioned in the wake of a decade of damning revelations about elderly care, the report from the NHS Confederation, Age UK and the Local Government  Association contains 48 draft recommendations and urges ‘fundamental changes to culture, leadership, management, staff development, clinical practice and service delivery'.

It calls for a named staff member to be responsible for each patient's discharge to ensure the right support is in place when they leave hospital.

On the GPs' role, it says: ‘At present discharge summaries are not routinely shared with a patient's GP. These documents contain valuable information which can help determine subsequent care, and should always be sent to the GP. This is in line with the recommendations in the 2012 NHS Future Forum report on information.

‘The GP should then arrange for a follow-up assessment around six weeks after an older person has been discharged from hospital. This should check whether care arrangements put in place when the patient was discharged are still appropriate. The outcome of the assessment needs to be discussed with the person themselves, their family and carers, as well as their health and social care support.'

The report also calls for CCGs' authorisation to hinge on their plans for securing dignified care for their elderly patients: ‘When the NHS Commissioning Board is deciding whether to authorise a local clinical commissioning group, it needs to judge the effectiveness of the group's plans to secure dignified care for older people through its contracts with providers of  NHS funded services.

Sir Keith Pearson, chair of the NHS Confederation said: ‘We want this report to be a call to arms to the whole health and social care system. We need to work together to earn back public confidence. We know there are some hospitals and care homes providing great care, and we need to learn from them to get dignified care right for every person every time.

‘Solving the problems will require the consistent application of good practice and the rooting out of poor care. But we also need to trigger a major cultural shift in the way everyone in care thinks about dignity to ensure it is person-centred and not task-focused.'

Dr Helen Hosker, a GPSI in intermediate care and urgent care lead for central Manchester CCG said she thought the report was 'unrepresentative' of the quality of elderly care she witnessed as a GP and questioned its recommendations.

She said: 'There are two things about hospital discharge information – timeliness and quality – and the problem is with the quality. Timeliness is easy to audit and measure but it doesn´t mean to say its going to be worth the paper it´s written on.'

'I don't think it should just be the responsibility of GPs to review discharged elderly patients – it should be the appropriate person who might be from health or might be from social care. We need to develop integrated teams for this, not always the GP.'

Dr Hosker also disagreed with the recommendation regarding CCG authorisation: 'Dignity should be one of a number of quality measures. There's a case for this with all vulnerable patient groups – including children.'



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