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A lift for older people

Plans to bring back old-fashioned GP care for those aged 75 and above will be good news for many, but how workable is it? 

My mother is 86 years old with diabetes, some cardiac failure and increasingly limited mobility. She is highly responsible in administering her medication and daily injections, eats well and keeps her mind active with reading, music and crosswords. She lives alone and it takes her until midday to get up and face the world. She is cheerful, grateful and she enhances our quality of family life. Just like many older people in the UK.

It has not been a good week for Mum. She needs an appointment to see her GP as the fluid in her ankles is spreading to her thighs and she is getting short of breath. The only pre-booked appointment the surgery can offer after midday is six weeks away. If she wants one before then, she must call the surgery at 8am to claim an appointment on that day. She has not been successful. Eight am is very early for her to function: she is dizzy and groggy and has dropped the phone twice then fallen trying to retrieve it. The surgery line is generally engaged so she can't get through. When she succeeds, all the appointments have gone for that day. The nice receptionists always encourage her to try again the next day. And so it goes on. She is now short of sleep, sleeping fitfully to get on the phone by 8am and her oedema is worse - but she feels reassured that she has that appointment in six weeks' time in case she never gets through.

Hearing the government announce that old-fashioned family doctoring is coming back for those over 75 years old was great news to my Mum - and probably many others. The GP contract renegotiation means 25% of the quality and outcomes framework (QOF) is being substituted with pro-active strategies to improve out-of-hours services and reduce over-75 attendances at A&E, who currently make up one third of emergency admissions. Four million people over 75 will have a 'named' GP responsible for co-ordinating their healthcare and the frailest one million will get an enhanced care package.

That means the 75-and-overs will be able to have a same-day appointment with 'their GP 'like the 'good old days'? Not quite. After hearing a BBC interview with the Health Secretary, Jeremy Hunt, it was obvious the headlines did not match the facts. He indicated they would not be able to see 'their GP' necessarily - but they would be able to see another GP, or someone would telephone them. Mum's excited - but I'm sceptical.

How will they manage appointments? What happens at night and weekends? Who will have access to accurate patient records indicating frailty, degree of dementia and current medication?

The majority of elderly people want continuity and familiarity. To avoid deterioration and to keep them away from A&E, they need responsive and timely consultations with an array of near-patient testing, regular medication monitoring and motor and cognitive reviews. If GPs do swap their QOF box-ticking for seeking out those registered elderly patients requiring such care, then doctors, nurses, patients and carers might be happier - and the pressure on hospitals reduced. Sounds great; community specialist nurses who have been dealing with long-term conditions, palliative care, mental health/dementia issues and unable-to-engage GPs will be especially pleased to see them more involved!

All the evidence suggests that social care is as equally important as healthcare. The biggest barrier to hospital beds is the inability to arrange a safe discharge of elderly patients back into the community, especially in winter.

GPs will be responsible for the social support and adaptations needed to keep people in their homes, organising safe, speedy discharge from any inevitable hospitalisation - and visit patients once home. Social work teams will welcome GP engagement.

What happens to those patients under 75 years old? Same old scrabbling for appointments via the telephone at 8am everyday? Looks like it - but online appointments and repeat prescription requests are expected from April 2014. GP appointment lengths are to be flexible to patient need - an improvement on the required 10 minutes at present.

Caring for the rising number of elderly in our society is a mammoth and complex task. Something needs to change.