Dr Chris Barclay argues that without extra resources, GPs will not be able to implement the latest national service framework
Both the absolute numbers and proportion of elderly in the population are increasing rapidly. What we aspire to for ourselves and society in general is that the 'third age' is characterised by golden years, not a remorseless decline into senility and neglect.
The National Service Framework for Older People,1 is the Government's plan to modify and improve social and health services for the elderly, a significant proportion of which is to be implemented by GPs.
The document sets out a 10-year programme for action and reform, aiming to integrate and improve access to health and social care, raise standards, promote independence, and help old people to stay healthy.
There is a commitment to 'root out discrimination'. This is to be achieved by implementing eight standards, three of which specify GPs, and one that does not but should.
- Standard Five: Stroke. By April 2004, GPs will be required to identify, treat and audit those at risk of stroke or who have had a stroke, and have an agreed protocol on the rapid referral and management of transient ischaemic attacks. This should be relatively straightforward. It basically requires GPs to be more strategic in planning the services they offer their patients.
- Standard Seven: Mental health in older people. PCG/Ts are to ensure that every general practice has in place an agreed protocol to diagnose, treat and care for those with depression and dementia. There is, however, a risk that measuring unmet and perhaps largely unmeetable need could be counterproductive. The question of resources will be vital to meaningful implementation of this standard.
- Standard Eight: The promotion of health and active life in older age. For GPs this will be measured by demonstrating year-on-year improvements in flu immunisation rates, smoking cessation and blood pressure management. High-achieving GPs may well have difficulty squeezing through this hoop.
- Standard Six: Falls. As falls can result in serious injury, loss of independence and even death, this is a worthy area for action. I was surprised that GPs, who are ideally placed to implement the recent RCP/BATS guidelines2 on the prevention of first and subsequent osteoporotic fractures, were not included in the 'key intervention' or 'milestones' part of the plan.
- In addition, there is a section on medicines in older people. This lists eight areas where prescribing can and must be tightened up to improve efficacy and safety while at the same time reducing adverse effects and waste. By April 2002, we will be obliged to review prescriptions annually in the over-75s and 6-monthly if they take four or more medications. What is required really falls within what most GPs would consider good practice.
I would be delighted to implement the requirements of this NSF, but fear that it undervalues the potential of general practice and will therefore direct much of the necessary resources elsewhere. The NSF's apparent financial backing is massive, but will it enable me to offer a meaningful review of the health and health needs of every 75 year old every 6-12 months? I do hope so.
At present the irresistible tide of illness and demand requires me constantly to triage and process cases just to keep up. As is always the case, no-one ever tells you what current work you can stop in order to take on the new work. I hope this will not be another 'more work for less pay' scheme.
- See also 'News' in this issue
- DoH. National Service Framework for Elderly People. London, DoH, March 2001.
- RCP/BATS. Osteoporosis: Clinical Guidelines for Prevention and Treatment. Update on pharmacological interventions and an algorithm for management. London: RCP, 2000.