Skip to navigation

Fact sheet

A checklist for GPs and Primary Health Care Teams

  1. How many of your patients who are carers, and patients who have a carer, have you identified? Are you implementing all of the methods for carer identification outlined in the report?
  1. Do you refer carers to local sources of advocacy, help and support, including an assessment by the Local Authority and Carers’ Centres or carers support groups?
  1. Do you take carers’ special needs into account in terms of the way you allocate appointments?
  1. Do you take carers’ particular home circumstances into account in your procedures for issuing prescriptions and for home visits?
  1. Do you take carers’ particular needs into account in your arrangements in the waiting room?
  1. Do you check carers’ health whenever a suitable opportunity arises, and at least once a year?
  1. Do you ask patients who have carers whether they are happy for health information about them to be told to their carer and do you give carers information about the diagnosis, treatment and prognosis for the person they care for and about medication and its side effects?
  1. Do you arrange for your staff to have information and training to make them ‘carer aware’ and to ensure that all relevant practice systems and protocols reflect the needs of carers? Will you identify a member of staff to take the lead on carers’ issues?
  1. Are you willing to actively encourage the involvement of local Carers’ Centres and carers’ organisations in the work of your surgery?
  1. Will you use the opportunities presented by practice based commissioning to develop services and support for carers?

1. How many of your patients who are carers, and patients who have a carer, have you identified? Are you implementing all of the methods for carer identification outlined in the report?

Identifying carers who are patients and patients who have a carer remains an essential pre-condition for any effective improvement in the support given to carers by primary care services. In the last checklist (Primary Carers) we asked whether practices had identified their patients who are carers or who have a carer.

We have re-phrased the question. We have done so because although under the new contract, the large majority of practices have claimed the relatively small amount available for establishing a register and referring carers for assessment, 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. Even GP practices with good and well established links to Carers’ Centres are not always managing to identify even all the carers with substantial needs. Identifying some carers may be enough to meet the requirements of the new contract but is not enough to make a real change to those carers’ lives. If we take a typical five-doctor practice looking after about 8000 patients, about 800 of these will be carers, of which about 270 will be caring for more than 20 hours a week, including about 160 who are caring for more than 50 hours a week – considerably more than a full-time job. These figures should be used as a benchmark by practices to self-assess how well they are doing in identifying carers. This report outlines many methods of identifying carers which should be examined by practices.

Back to top

2. Do you refer carers to local sources of advocacy, help and support, including an assessment by the Local Authority and Carers’ Centres or carers support groups?

The contractual requirement under the QOF framework is to refer carers to the Local Authority for an assessment of their needs. It is assumed therefore that this is happening in those practices which receive this payment but it needs to be monitored. A survey carried out by The Princess Royal Trust for Carers in 2002 found that over 70% of carers who were caring for more than 50 hours per week had not had an assessment of their needs. Yet, among carers who had had an assessment, over half had seen a change to the support or services that they received. Heavily committed carers in particular should have an assessment.

But whilst this assessment is very important, it is only part of the picture. Carers cope with a wide range of challenges and difficulties and may have a variety of support needs, not all of which may be picked up by the formal assessment. Also, there is no need to wait for that assessment before putting carers in touch with sources of support to meet their needs which will vary between carers at different stages of caring. The network of Carers’ Centres run by The Princess Royal Trust for Carers and other agencies can offer opportunities for advocacy and help with benefits or other financial information. The chance to meet others in the same situation and to be offered services such as short breaks, ‘pampering’, counselling or opportunities for training. Also, some GP practices do not have in-depth specialist knowledge or expertise in some conditions which give rise to caring situations such as learning disabilities or mental illness. There are national and local organisations that do specialise in these conditions and can provide information and support to carers. Practices that link with other organisations in this way can also benefit by keeping up to date with developments in knowledge about the condition.

Back to top

3. Do you take carers’ special needs into account in terms of the way you allocate appointments?
Appointments can be a particular problem for carers who often have less flexibility than other patients about when they can attend for an appointment, because it may need to be timed to fit in with their caring responsibilities (thus an early morning appointment may often be unsuitable) or when they can arrange alternative care. For the same reasons they may have less flexibility than other patients to wait if a surgery is running late. There is strong evidence that the health of carers is adversely affected by their caring role. Giving carers priority in appointments may help to preserve their health and that of the person they care for, and in certain circumstances can avoid hospital admissions. There has been a centrally-driven policy priority to ensure that patients can see their GP within 48 hours or a healthcare professional within 24 hours. In some cases this has led to problems of patients trying to get through on the phone in the early morning to try to obtain appointments which are ‘released’ that morning. This can be much more difficult for carers to do. It is significant that in our demonstration projects, this is one area in which there was not improvement as perceived by the carers. We are not suggesting a prescriptive model here, but merely that practices should be carer-sensitive in the way in which they devise their systems, and flexible in their approach to the needs of carers.

Back to top

4. Do you take carers’ particular home circumstances into account in your procedures for issuing prescriptions and for home visits?

Prescriptions is another area where carers often experience particular problems. They often have less ability than other patients to drop off or collect prescriptions at the surgery and would benefit from being able to phone in prescription requirements and being advised about how to have the prescription collected and medication delivered for them. Similarly, the home circumstances of the carer may make it difficult for them to attend surgery for their appointment, even if the condition itself would not normally merit a home visit. GPs and their staff should be prepared to respond sensitively to this. It is also good practice to take along the medical records of the carer when making a home visit for the cared for, and check on the carer’s health at the same time.

Back to top

5. Do you take carers’ particular needs into account in your arrangements in the waiting room?

A further problem for carers identified in surveys and in our demonstration projects is the waiting room arrangements. Sometimes this may be due to embarrassment about the behaviour or nature of the medical condition of the person being cared for and the reactions of other patients to them. Another problem is the lack of confidentiality when talking to reception staff. Although this is not confined to carers, it is probably a more frequent problem for them than for other patients, particularly if they are asking for special arrangements. Changes to the physical environment are needed to take into account the circumstances of, say, patients with autism or dementia or those with equipment such as wheelchairs or oxygen bottles. This is a longer-term issue but sometimes small changes can be made which can make a big difference, such as using existing smaller rooms for patients to wait in when the general waiting room is less suitable for them.

Back to top

6. Do you check carers’ health whenever a suitable opportunity arises, and at least once a year?

The White Paper states that the NHS will develop a new Health ‘Life Check’ service to help people particularly at critical points in their lives. Given the evidence about the adverse effect on carers own health of the caring role, and the often serious consequences of a breakdown in carers’ health, it makes sense for the NHS to monitor carers’ health, just as it does for other groups such as diabetics or those with heart problems. Some practices have introduced such checks, sometimes in carers clinics which are combined with advice being given on other areas by a Carers’ Centre worker. Carers are regularly in touch with the NHS, having contact with GPs, district nurses and community nurses. While many of these contacts may be about the health needs of the person cared for, they also present an opportunity for the primary care professional to review the carer’s own health and their ability to continue caring.

Back to top

7. Do you ask patients who have carers whether they are happy for health information about them to be told to their carer and do you give carers information about the diagnosis, treatment and prognosis for the person they care for and about medication and its side effects?

In the Carers Speak Out survey in 2002 many carers told us that they were not being given adequate information about the diagnosis, treatment, medication or future development of the illness or disability of the person they cared for.

While there may be issues of patient confidentiality in some cases, it is more often a problem of GPs and other primary care professionals not being sufficiently pro-active in seeking the patient’s consent for this key information to be passed on to the carer. The evidence suggests that carers who are given more information feel more positive about their caring role and the influence they have over services for the person they care for. If the oft-repeated mantra that carers are partners in care is to mean what it says, this is an essential requirement.

Back to top

8. Do you arrange for your staff to have information and training to make them ‘carer aware’ and to ensure that all relevant practice systems and protocols reflect the needs of carers? Will you identify a member of staff to take the lead on carers’ issues?

One of the best ways to ensure that practice systems reflect the needs of carers is to give all staff – clinical and administrative – training in carer awareness. The local Carers’ Centre will often be more than happy to do this. This can be very effective in promoting the opportunistic identification of carers arising out of the routine contacts the practice has with its patients. This can then be followed by a review of practice protocols and procedures, preferably with some direct involvement from either the Carers’ Centre or from carers within the practice, to ensure that they properly respond to the needs of carers. We have found repeated evidence of the impact of such awareness training and the motivation of staff which can result from it. This should be complemented by the appointment of a member of staff to take the lead on carers’ issues, and ensure that all aspects of the practice organisation are carer friendly.

Back to top

9. Are you willing to actively encourage the involvement of local Carers’ Centres and carers’ organisations in the work of your surgery?

Many practices have a regular visit from a carers’ worker from the local Carers’ Centre or organisation to provide advice and support to carers in a clinic, and have found this an invaluable aid to their work and of great value to their patients who are carers. Some GP practices have also established practice-based support groups, which complement services delivered in the surgery by the local Carers’ Centre. In some cases practice staff participate in the group, whereas in others the surgery makes a room available for the group, but does not participate directly in it. In other areas the carers support group is based in the local Carers’ Centre. The best practice depends on local arrangements and what carers find to be of value. The important thing is to recognise that the local GP practice can often be an appropriate place for such developments.

Back to top

10. Will you use the opportunities presented by practice based commissioning to develop services and support for carers?

Practice based commissioning will give GPs and other members of Primary Health Care teams greater influence and control over how their local PCTs use resources. Potentially this presents a powerful opportunity to improve support and services for carers. This can apply not only to services commissioned from other parts of the NHS, but from other agencies as well. For example, greater priority could be given to the commissioning of services from the local Carers’ Centre, some of which might be delivered ‘on-site’ at local surgeries.