BGS Rising Star Awards: Ruth Law and Thomas Jackson

The BGS Annual Rising Star Award recognises young doctors, nurses and AHPs who have made exceptional contributions to the field of older people's health care, early in their career. Two awards are available each year; one for research contributions that have translated into, or are in the process of being translated into, improvements to the care of older people, and the other, for a clinical quality project which improves the care of older people with frailty in the award holder's locality.

In 2018, the award for quality went to Dr Ruth Law, Consultant in Integrated Geriatric Medicine, Whittington Health, for her work with the Integrated Community Ageing Team (ICAT) in Islington and to Dr Thomas Jackson for the work he has been doing in research.

Ruth trained mainly in and around London. She says that her training included a formative year as part of the stroke team at the National Hospital for Neurology and Neurosciences where she had the privilege of working alongside world-class researchers as they developed a new service.

"This training provided a good springboard into my consultant post as I found myself with a new title of ‘integrated geriatrician,’ a request to ‘do something about care homes’ and an absence of any blueprint to follow."

"With the support of my department and our local GPwSI in Geriatrics (Dr Philly O’Riordan) the ‘Integrated Community Ageing Team’ (ICAT) soon came into being. For the first year we focused on supporting our ten local care homes (all dual registered)."

"We created link geriatricians to deliver CGA in the care homes, spent time working alongside the existing care homes GPs and began monthly MDMs. On the secondary care side, we offered access to geriatrics advice in working hours via a hotline, created rapid access slots in clinic for assessment and made sure any care home admissions received rapid review by a geriatrician."

"With this relatively simple intervention we saw a sustained drop in unplanned admissions from care homes by 26 per cent." "The success of ICAT opened doors to becoming involved in raising the national profile of care homes medicine. Within months we had been invited to speak at the launch of the Five Year Forward View at The King's Fund with its particular focus on care home medicine. I contributed to NHS England’s winter toolkit for care homes and spoke at the Royal College of Physicians Future Hospitals event."

"Thankfully our success also led to cost savings which our commissioners re-invested in community geriatrics and so, in year two, we widened our scope. We recruited a frailty specialist MDT (occupational therapy, physiotherapy, pharmacy and nursing) and started to deliver CGA in the homes of community dwelling frail older people. Now in its third year, this service is widely valued by patients and GPs and we are currently involved in supporting local GPs to identify more of the frail patients on their lists and offer tailored interventions."

"Reflecting on the growth of both the care home and general community services I feel there are three key elements to growing a quality service, namely patient and primary care involvement, and interdisciplinary education."

Patient Involvement

"With the support of Islington CCG we were able to involve Healthwatch in undertaking a resident feedback exercise around integration, early on in our care homes work. The positive results gave us the momentum and local support to move forward at pace. We continue to collect patient’s views every quarter ,as part of our ongoing service development. The team are particularly passionate about supporting older people to access the services they are entitled to, and prioritising integration of services within a person’s care plan."

Primary care

"From the outset, Islington’s GPwSI in Geriatrics (Dr Philly O’Riordan) has been involved in the operational and clinical side of the service. This has enabled us to develop in a way that dovetails appropriately with existing services in primary care and does not generate extra work. We have also chosen to fully integrate our IT with Islington primary care and work on the ‘EMIS’ system, used by every local GP."

"With patient consent we are able to view the GP record in real time, and type our notes so that they can be viewed directly and immediately. This means we have access to all documents, prescriptions and investigations relating to a patient when referred. We have put effort into visiting local surgeries, speaking at practice meetings and attending relevant commissioning meetings to maximise opportunities for improving communication and building relationships with our GP colleagues. The efforts we have made to work together with primary care are highlighted in this RCGP publication"

Interdisciplinary education

"The power of CGA as an intervention lies in the team, and we are proud of the integrated community ageing team, their commitment to patients and each other. Our focus on interdisciplinary education underpins this. With the support of the interdisciplinary philosophy at Whittington Health we have been able to maximise opportunities for learning together, rather than in professional silos. The team have trained in areas as diverse as advanced care planning, vestibular examination and ‘stop smoking’ training. Learning together has built deeper professional trust and makes day to day working more efficient and enjoyable."

"The common thread that joins these three elements is of course, time. Time with patients, time with GP colleagues, time to learn together, time to develop ideas. By some standards we have achieved a lot in three years, but we have still felt the pressure to do things more quickly."

"I strongly believe that the key to quality is allowing the time needed. Paradoxically things have happened faster and more effectively, precisely because we have not rushed."

"Moving forward we will continue to work closely with our colleagues in primary care, neighbouring trusts and the CCG to deliver the patient-centred, integrated service our patients deserve."

The research award went to Dr Thomas Jackson. Speaking about his work, he says: "I am currently working as a clinical academic geriatrician in the Institute of Inflammation and Ageing at the University of Birmingham. Clinically I work as a consultant orthogeriatrician at the Queen Elizabeth Hospital, Birmingham."

"My current work hopes to understand the immune-inflammatory basis of delirium, and how this impacts on the development of longer term cognitive outcomes, as well as understanding how our ageing immune system may drive frailty and sarcopenia."

"My PhD was on pragmatic methods to identify dementia in older people with delirium, and the effects of clinical subtypes and inflammatory profiles of delirium on outcomes. The BGS has been central to this as I was funded through a joint Research Training Fellowship with the British Geriatrics Society in 2012, and the BGS has helped fund further work through Spr start-up grants to colleagues I work with."