Delivering proactive care for older people with frailty
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The British Geriatrics Society ( BGS ) has released a report that outlines how to deliver proactive care against core components and key enablers , acting as a roadmap for implementing the NHS England framework and delivering proactive care services .
Be proactive : Delivering proactive care has eight recommendations . The first is that proactive care services should be aligned to the approximate geography of a Primary Care Network ( PCN )/ Primary Care Cluster ( PCC ) or equivalent , with a dedicated proactive care team in each equivalent area across the UK .
The second recommendation is that policy makers and commissioners should prioritise national funding and contractual arrangements to ensure that proactive care is available to all older people living with frailty in the community .
It also recommends that leadership is vital to the delivery of successful proactive care services , and it should be supported and nurtured through training opportunities and protected funding .
Furthermore , the report says that outcome measures are vital in evaluating the success of proactive care interventions and should always be implemented when new services are launched .
It calls for national guidance on how to measure the impact of proactive care interventions to be published , and says investment is needed in clinical research and IT infrastructure , focused on data collection and evaluation .
The fifth recommendation is that proactive care services should be staffed by a core multidisciplinary team , consisting of at least one GP with an interest in frailty , one advanced clinical practitioner , and one care co-ordinator .
BGS says that ‘ a gold standard team would include professionals from social care , mental
health services , therapies , pharmacy and geriatric medicine ’.
The final three recommendations are for local and national investment in training and development opportunities for the multidisciplinary team working in proactive care , including mandatory frailty training , training in communication , leadership , and coaching , and education on the wider health and care system .
A culture of flexible and cross organisational working should be embedded in proactive care services . And that services across the UK should use its Be proactive : Evidence supporting proactive care for older people with frailty to make the case for proactive care services in their local area and as a roadmap for implementing services .
Dr Jennifer Sutton , RCOT Project Lead ( CAHPR ), who was a member of the advisory board that informed the content of the report , commented :
‘ This report really illustrates the importance of multi-disciplinary team working in proactive frailty care . It includes six different real world case studies of proactive frailty services , which have been set up and led by occupational therapists and / or include occupational therapists as key members of the multidisciplinary team .
‘ The document is aimed at healthcare professionals , clinical leaders , policy makers , and commissioners and acts as a roadmap for delivering proactive care for older people with frailty .
The document is aimed at healthcare professionals , clinical leaders , policy makers , and commissioners and acts as a roadmap for delivering proactive care for older people with frailty .”
‘ A huge credit and thank you to RCOT Professional Adviser Genevieve Smyth , who I was able to work with on this , and to our amazing RCOT members . The case studies were gathered through engaging with our RCOT primary care network .
‘ It ’ s fantastic that their innovative work is being cited as examples of good practice in this document ; it further cements the role of occupational therapy in this important area of practice .’
Download the report at https :// bit . ly / 3Pp TFgm .
10 OTnews January 2025