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Fact sheet

GP surgeries - changes to routine services

Adapting existing services for family or unpaid carers needs

GP practices can slightly alter the services they provide to better account for carers’ needs. These are simple and easy to implement at no cost, but make a considerable difference to the lives of carers and the people they care for.

Your local carers centre will have some good ideas on ways in which this can be done. And, of course the carers that already access your surgery will have useful thoughts on changes that would benefit them.

Useful changes can be made in the following areas:

  1. Priority appointment systems
  2. Repeat prescription services
  3. Carer-allocated waiting room
  4. Home visits
  5. Flu vaccinations

1. Appointment systems

Appointment systems should recognise the special circumstances experienced by carers and the people they care for, which may affect their ability to fit in with the normal system for appointments. The implications of this may often not have been made apparent to the surgery staff involved.

If it is an appointment for the carer, they may have to arrange alternative care. Even when this is not necessary, some carers cannot be away from home for long periods, making it impossible to wait if the surgery is running late or the system requires uncertain periods of waiting to see the doctor.

The carer may also wish to discuss issues around the health of the cared for as well as their own health. Indeed, the former will often be affecting the latter in a significant way.

If the appointment is for the cared for person, it may have to be at a time when the carer is able to make appropriate arrangements, such as travel arrangements. There may also be a limit on the time for which the cared for person can comfortably wait in the surgery with the carer.

A number of ways to alter the appointment system have been developed by practices in the last few years to help carers and the people they care for (this list is by no means exhaustive and carer input would help establish the most useful methods):

  • Allowing ‘fast-track’ appointments to be made by carers
  • Reserving the appointments at the beginning or end of a surgery for carers or patients with carers to minimise waiting time
  • Giving carers double appointment slots
  • Allowing appointments outside the normal surgery time, to fit in with the carers’ situation
  • Telephoning carers with an appointment to advise them if a surgery is running significantly late so that they can minimise the time away from the cared for person

The Leeds carers protocol suggests double appointments for carers so that they can discuss the health of the cared for as well as their own health. It also suggests that carers who have difficulty in making appointments could be offered the otherwise embargoed ‘book on the day’ appointments in advance.

When patients with an identified carer (or the carer themselves) ring the Orton practice in Peterborough for an appointment, the staff are authorised to make special appointment arrangements if necessary to fit in with the carer’s situation.

Worcestershire Association of Carers suggest a five-point plan for carer and cared for appointments: advance booking; appointments when there might be least waiting time build-up; appointments later in the day; double appointments; appointments in downstairs rooms if cared-for mobility is impaired. They also appeal for a recognition that carers are not being ‘difficult’!

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2. Repeat prescription services

This is another area which can cause difficulties for carers, despite the increase of home delivery services by pharmacies for those who struggle to collect prescriptions personally.

Procedures and rules on repeat prescriptions vary by practice of course, so our suggested alterations must be tailored so they are most easy to implement and of most use to carers. Again, the following list is not exhaustive and carer input would throw up further ideas:

  • Making carers exempt from prohibitions on ordering repeat prescriptions by phone;
  • Periodic medication reviews allow carers to communicate how they and the patient are coping with the condition.

In Wandsworth, Medication Review Cards have been used. This card allows patients to list all repeat medication and dosages and detail any problems they are experiencing with the medicine. The patient or their carer can present this to a health professional and prompt the appropriate medication review level. During Ask About Medicines Week, the cards were particularly aimed at vulnerable, hard-to-reach groups and were distributed at a Carers’ Conference.

The Orton practice in Peterborough has certain times when repeat prescriptions can be ‘phoned in but does not apply this restriction to carers. In similar vein, the Greenwich protocol specifies that there should be a separate time for carers to call.

The Worcestershire Association of Carers asks that practices recognise that carers might legitimately request advance or extra prescriptions to cover holidays or when respite care is being given.

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3. Carer-allocated waiting room

Waiting rooms nearly always lack privacy, which can cause difficulties for carers who are looking after patients who find it difficult to wait in public or whose behaviour can cause difficulties or embarrassment to their carer due to the reaction of other patients.

This may cover a range of situations including parents accompanying children with autism, or spouses accompanying a partner who is suffering from dementia. It may be possible to offer a separate and quieter place to wait where the patient or the carer will not be affected so much by the number of people in the waiting room or their reaction.

There may also be other aspects of the waiting areas which could be looked at. For example, the provision of brightly-coloured play areas and toys, which may be appreciated by most parents and their children, may actually cause problems for a child with autism. This is an example of something which may arise out of consultation with carers themselves which is unlikely to occur to practice staff.

Patient Satisfaction Questionnaires can also provide feedback on problems being experienced by patients and by carers.

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4. Home visits

It may be appropriate to consider home visits for some carers, or the person they care for, to take account of the caring situation even if the particular presenting medical condition might not normally indicate that this is appropriate. This should be offered automatically in appropriate cases and carers should not be made to feel guilty if they make such a request.

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5. Flu vaccinations

Many carers already fall into the ‘at risk’ group for flu vaccinations. The consequences of a carer falling ill with flu can be stressful for all involved, can be costly for statutory services and can have a detrimental effect on the health of the person being cared for.

Carers are now included in the national recommendations for flu vaccinations. (LINK to document from DoH) Offering free flu vaccinations to carers can reduce the likelihood of a sudden crisis occurring if the carers health breaks down to the point where they can no longer continue to care.

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GP surgeries – new services for carers