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Fact sheet

A Checklist for Primary Care Trusts and Strategic Health Authorities

  1. Do you produce a local protocol for systems within primary care to identify carers and link them to support, and do you commission work to set up such systems within primary care?
  2. When monitoring the implementation of QOF Management Standard 9 relating to the identification of carers, will you examine the numbers of carers identified as well as the process?
  3. Do you involve carers’ representatives, as partners, in the planning of local services?
  4. Do you make assessments of the level and quality of support for carers provided by the primary care services that you commission and do you incorporate support for carers into your local protocols for clinical governance and GP and practice appraisals?
  5. Do you use the flexibility in PMS contracts and the options for enhanced services in the GMS contract to encourage and reward GPs to extend and improve services for carers?
  6. Do you commission services to support carers from a local Carers’ Centre or other voluntary or statutory agency?
  7. Do you include carer awareness in the training you offer to members of Primary Care Teams and encourage practices to have a ‘carers lead’?
  8. Do you include carer awareness in the training for your own staff, members of the PCT Board and Professional Executive Committee?
  9. Do you ensure that the needs of and services for carers are considered by the partnership with the Local Authority and other agencies?
  10. Do you ensure that the needs of and services for young carers are included in strategies for children’s services?

1. Do you produce a local protocol for systems within primary care to identify carers and link them to support, and do you commission work to set up such systems within primary care?

Support cannot be offered to carers who have not yet been identified. Primary care is one of the most important and frequently used avenues by which carers come into contact with statutory agencies. It is important that systems are set up within primary care to identify carers and link them to support. Identification by itself is of limited value because it can only affect the services offered by the practice itself (and may not even do that).

It is unrealistic to expect the practices themselves to be aware of and develop all the available methods. A number of PCTs have developed local protocols to assist practices to do this or have adopted protocols developed by their local Carers’ Centre. Other PCTs have produced local standards against which to assess practices. There is also no point in re-inventing wheels either between PCTs or between practices.

Despite the obvious value of such development work to the NHS, many of the local primary care projects that have been established to do this have received no funding from the NHS, and the funding for some of those which have, has been withdrawn or not renewed. It is very important that funding is planned over a sufficiently long period to enable the schemes to become properly established and to cover all the GP practices.

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2. When monitoring the implementation of QOF Management Standard 9 relating to the identification of carers, will you examine the numbers of carers identified as well as the process?

The standard refers to the practice having a protocol for the identification of carers and their referral for a Social Services assessment. As written, this is rather vague, and makes no reference to the effectiveness of the protocol in identifying carers. Our research has indicated that it is possible to have a protocol in place, but still not identify a significant proportion of the carers.

There is a danger that audit and monitoring will examine the processes rather than their outcome. There is a further danger that because it is only worth three points out of 1050 in the overall framework, that it is not given the same priority for detailed audit as other elements in the framework.

We know approximately how many carers to expect in a given practice population and this should be used as the benchmark information against which to assess practices’ performance.

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3. Do you involve carers’ representatives, as partners, in the planning of local services?

PCT Boards are now required to confirm their compliance, or otherwise, with a number of Core Standards. Two of these are as follows :

Standard C14c – Healthcare organisations have systems in place to ensure that patients, their relatives and carers are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery.

Standard C17 – The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving healthcare services.

These are demanding standards, and the inclusion of carers in both of them is significant. Standard 14c is generally interpreted in the context of responses to formal complaints. However, ‘concerns’ should be wider than formal individual complaints, and should include views on overall service provision and development and the extent to which it recognises and responds to the needs of carers. We believe that when the Healthcare Commission publishes the results of this quality assurance exercise, there will be many places in which concerns have been expressed about the inadequate response to carers issues, but where the PCT has declared itself complaint with C14c.

Standard C17 requires PCTs to seek the views of carers and take them into account. Again, there are many PCTs who do not do a great deal to actively seek the views of carers but we predict that the overwhelming majority of PCTs will have declared themselves complaint with these standards.

This is important because there are many areas in which the input of carers would be valuable in local implementation schemes and other planning forums. These should include, for example, the planning and design of new primary care facilities through the LIFT programme; service protocols which should take account of the special needs of carers; and system planning to avoid hospital admissions and delayed discharges. Carers have a specific and unique contribution to make, based on their experiences, which can add value to the process and make a positive contribution to the achievement of NHS objectives.

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4. Do you make assessments of the level and quality of support for carers provided by the primary care services that you commission and do you incorporate support for carers into your local protocols for clinical governance and GP and practice appraisals?

PCTs have an important role in promoting and initiating good practice. If a Primary Care Trust relies solely on those GPs who are already interested in and committed to the needs of carers to take this agenda forward, progress will be much more limited than it need be. Also, wide variations between practices will continue to exist, creating further health inequalities for carers. PCTs should use their levers to review progress and where necessary encourage practices to change their ways of working.

The PCT should build up a picture of what is happening for carers in its area by asking those from whom it commissions services to provide information about what they are doing to support carers. With such an assessment, it will be possible to measure progress and to benchmark your area against other comparable areas. The provision of such baseline data is also essential for monitoring the impact of new initiatives. PCT staff may themselves be carers and they could be included, both in the assessment and to give input to ensure that family-friendly policies reflect the needs of staff who are carers.

It is important to look at the way practices deliver their day to day services, and the extent to which that recognises and responds to the special needs of carers. Appointments, prescriptions and waiting room arrangements are three such areas. We have identified these in the checklist for practices but it is important that PCTs give comparable priority to monitoring these areas as is given to other service delivery objectives, such as meeting the targets on the ability to see a doctor or healthcare professional within 48 or 24 hours. For carers, these issues can be just as important as the more high profile targets.

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5. Do you use the flexibility in PMS contracts and the options for enhanced services in the GMS contract to encourage and reward GPs to extend and improve services for carers?

The contractual arrangements with GPs present opportunities on a local basis to negotiate and agree with practices about the introduction of initiatives to extend and improve practice-based services for carers. This might include a range of things, such as ‘Well Carers’ clinics or the establishment of dedicated nursing support to patients and their carers.

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6. Do you commission services to support carers from a local Carers’ Centre or other voluntary or statutory agency?

Our research leaves us in no doubt that carers find the range of services offered by local Carers’ Centres and other voluntary agencies to be immensely valuable in supporting them. These include diverse services such as financial and benefits advice, counselling, alternative care, training and a variety of activities which help to relieve stress. Various projects have provided testimony to the value of such support and services, some of which can be offered in the GP surgeries. Such support can contribute very positively to the maintenance of the carer’s health and in many cases actually prevent a breakdown of the caring situation, which would lead to more services being provided by the NHS and other statutory agencies.

Despite this, the funding for such work is often short-term and insecure, leading to failure to develop its full potential, key staff leaving for other jobs and an overload of cases for the staff involved. There has been evidence within the last year that such work can be particularly vulnerable during periods of financial pressure. We would recommend that PCTs take a longer-term view when assessing the value of this work and relate it to other policy objectives such as avoidance of hospital admissions.

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7. Do you include carer awareness in the training you offer to members of Primary Care Teams and encourage practices to have a ‘carers lead’?

PCTs support the training and development of GP practice staff, either financially and/or through direct provision of training. This is a significant element in their role of developing primary care. It is important that staff are provided with training in carer awareness, along with all the other clinical and administrative areas which constitute the development of quality services. Many practices have found that it is valuable to have a lead member of staff responsible for carers issues. All of this will encourage the interest in, and commitment of, practice staff to their projects for identifying carers and will also positively influence the way they do their job on a day to day basis.

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8. Do you include carer awareness in the training for your own staff, members of the PCT Board and Professional Executive Committee?

It is equally important for PCT staff and anyone involved in strategic planning and decision making to receive training in carer awareness. This should apply at all levels.

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9. Do you ensure that the needs of and services for carers are considered by the partnership with the Local Authority and other agencies?

A key theme of 'Our health, our care, our say' as it has been of numerous other requirements and guidance from Government has been the need for the NHS, Local Authorities and the non-statutory sectors to work in partnership. This is probably even more true in the area of support for carers than in many others. The relationship between PCTs and the Local Authority needs to be much more than simply getting GPs to refer carers for an assessment, as implied by the QOF Management Standard 9. There should be an integrated strategy for carers in each area, to which all agencies are signed up. The 2004 Act places a duty on primary care to give ‘due consideration’ to a request from Local Authorities for the planning or provision of services to carers.

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10. Do you ensure that the needs of and services for young carers are included in strategies for children’s services?

PCTs are also required to work in partnership with Local Authorities and other agencies, through Children’s Trusts and other organisational mechanisms in the development of integrated strategies for children’s services. Young carers should be identified as a specific group of children at risk, and services and support should be planned accordingly. There should be a specific strategy for young carers in each area. It is important that there should be close links between that strategy and the adult services, who are likely to be involved in many of the family circumstances of young carers, and that the new organisational separation between children’s and adult services provided by the Local Authority should not work to the detriment of young carers.