Working as an Extensivist GP

Dr Margaret Lupton is a GP in North West England with over 20 years’ experience in General Practice. She joined the Blackpool, Fylde and Wyre Extensive Care Team in January 2016. She is one of the key speakers at the BGS Autumn Meeting during the Community Geriatrics Afternoon on Wednesday 23 November. She tweets as @MagsieLup

I have been a GP for 20 years and over this time I have witnessed the patient population becoming gradually older with increasingly complex problems. Also, GPs have become more and more involved in their patients’ chronic disease management. The standard 10 minute GP appointment just isn’t long enough anymore to deal with these older patients who have complex needs. For a long time I have been interested in exploring new ways of working and new models of care and so when I got the chance to join the Blackpool, Fylde & Wyre Extensive Care Service, I jumped at the chance.

Extensive Care was originally an American concept providing care for elderly patients outside of a hospital setting with the medical input from Geriatricians. In our model we currently have one Consultant Geriatrician with the rest of the medical cover being provided by GPs. I joined the Service in January 2016 as the first permanent Salaried GP.  I was interested in the idea of having longer appointments for this cohort of patients and working as a member of a large multidisciplinary community team.

Our version of Extensive Care aims to provide holistic care to our patient population bridging the gap between primary and secondary care, rationalising their care where appropiate, reviewing their medications, reducing unnecessary appointments and reducing the burden on primary and secondary care from these patients who tend to be the “high flyers”, with higher than average use of Out of Hours Services, A&E and sometimes with frequent, often prolonged, inpatient stays. In view of the demographic of our patients we also address their long term planning and their wishes for future care and when necessary their end of life care. Patients are referred into the service with their consent by their GP.  They are seen first by their Wellbeing Support Worker in their home environment. They then have an initial assessment with their Clinical Care Co-ordinator and Extensivist Doctor which is based on a Comprehensive Geriatric Assessment.  Following their initial assessment we have a post-clinic huddle and draw up a plan for each patient.  Whilst they are under the Extensive Care Service we provide care on behalf of their GP, apart from their repeat prescribing and QOF-related care. Once they are under their service they have regular reviews depending on their individual needs.

I am enjoying working in this role very much and when I have done occasional GP locum sessions over the past few months I have found it very difficult to re- adjust to trying to see such complex patients in a 10 minute slot. Over the past 7 months I have seen huge differences made to patients’ lives from making simple changes – even with the most sick, most complex patients, the contact with the Wellbeing Support Workers and Care Co-ordinators is what makes the most impact for many patients. I saw a patient for her 3 month review today who completely unprompted summed this up nicely – “It’s just knowing that you’re all there that makes me feel better. It reassures me.”

I have also seen the devastating effect that unnecessarily prolonged hospital admissions can have on elderly patients and I have seen people deteriorate rapidly in the functional ability from a hospital stay. This has led me to become very interested in frailty and has made me acutely aware that we must develop different ways of dealing with acute problems in the elderly.

Register for the BGS Autumn Meeting HERE.