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GPs urged to collaborate more with geriatricians

Frail older population needs more joined up care

Adrian O'Dowd

Thursday, 24 November 2016

GPs must seek to work more collaboratively with geriatricians to deal with the ever-growing older population which has multiple conditions, according to a report published today.

The joint report* from the RCGP and the British Geriatrics Society contains positive case studies that demonstrate how GPs and geriatricians across the country are collaborating to design and lead innovative schemes to improve provision of integrated care for older people with frailty.

The 13 case studies from across the UK range from schemes to help older people remain active and independent, to those providing better services in the community, to those supporting patients in hospital.

In one example in Southampton, multi-professional teams, led by community geriatricians and GPs, conduct comprehensive geriatric assessments and person-centred care plans.

These often tap into local resources, such as healthy walks based around GP surgeries, set up in conjunction with Age Concern.

In Lothian, St Triduana’s Medical Practice has developed a simple, one-page form for relatives of new care home residents made up of just three questions to allow for a discussion with families about how a patient would like to be treated in the event of a serious illness.

In Nottingham, GPs in hospitals in Rushcliffe support the ward-based community team by offering sessions on the local health care of older people wards and re-admissions of patients aged over 65 have fallen by 8.7% since the initiative began last year.

The report is being launched today at the British Geriatrics Society’s national scientific meeting being held in Glasgow.

RCGP immediate past chair Professor Maureen Baker said: “Ageing and frailty are game changers for the health and social care services. GPs, in collaboration with geriatricians and other colleagues, are at the forefront of the response to these significant new challenges.

“This report outlines a number of exciting examples where college members have taken the initiative and put positive talk around integration of care into practice in order to improve patient care, their experience of the health services and health outcomes.

“The case studies demonstrate the value of the generalist approach that is shared by both GPs and geriatricians in delivering person-centred care. It is vital we learn from these examples of best practice and adapt our ways of working to reflect the changing needs of our patients.”

President of the British Geriatrics Society, Professor David Oliver said: “Older people with frailty and complex co-morbidities are proportionately the biggest users of health and social care services. They are also the most likely to use multiple services and risk disjointed care and support.

“GPs and geriatricians are expert generalists, respectively able to help co-ordinate care base on the needs of individual older people and their carers in their own homes or community healthcare settings and to oversee their care when presenting with or recovering from acute illness or injury in hospital settings and beyond.

“With a greater drive to more integrated care models, it is crucial that GPs and geriatricians work closely together across organisational interfaces and in emerging new models of services for older people.”


* Integrated care for older people with frailty: Innovative approaches in practice. Royal College of General Practitioners and British Geriatrics Society, November 2016.

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