Working with practices

Supporting carersMatthew Byrne

Head of Carers Services, Westbank, Devon

What will I talk about?

“Working in partnership with urban and rural practices to identify and support carers and

to deliver health and wellbeing checks.”

•A bit about Devon and Devon Carers•Clinics and drop-ins•Health and Wellbeing Checks (HWBCs)•Simple lessons from our practice•Does it make a difference?

Devon and Devon Carers

• Large rural county – 82,000 carers• Pockets of urban and rural poverty• Devon Carers

– provides information, support and short breaks– works with carers of all ages across Devon– includes targeted services around

• engagement and involvement• hospital discharge• young adult carers

– and works with ~100 rural/urban practices

Clinics and drop-ins

• We offer each one a monthly clinic/ drop-in staffed by a CSW (each does between one and six per month).

• We currently run clinics/drop-ins in more than 75 of the 100 practices.

• The approach taken varies from practice to practice.

• The lead in time can be six months plus.

Clinics and drop-ins

• Practices vary in what they prefer:– Some urban practices share premises and work

together to offer fortnightly clinics.– Some rural practices have multiple sites and the

clinics move around each month.– Some just have a monthly clinic on their main

site.

• Hosting and administration (generally) the responsibility of the practice:– Some are open access with no need to book.– Others work on an appointment basis.

Health and Wellbeing Checks

(HWBCs)• The HWBC is a holistic review of key areas

of health and wellbeing:– Wellbeing aspects are guided by the use of a

booklet (generally completed in advance).– Health aspects are based on an NHS vascular

check for those who meet the criteria.– The Health and Wellbeing (outcomes) wheel

provides a measure of change/improvement.

• Most HWBCs count as a Carers Assessment.

Health and Wellbeing Checks

(HWBCs)• A LES currently funds 50+ practices

(and 20+ pharmacies) to offer HWBCs.• Devon Carers staff also offer HWBCs:

– CSWs and peripatetic nurse(s).– Working directly with practices and in the

community (eg. village halls).– At carers forums and other events (eg.

libraries and workplaces).

Health and Wellbeing Checks

(HWBCs)• Devon Carers led development of the HWBC and

associated training/competence framework.• Devon Carers currently supports partner delivery:

– Training for partner staff delivering checks.– Advice and mentoring (directly and funding peer mentors).– Help with carer identification, including ‘kick-start’ funding

(eg. to tidy up carers registers).– Direct promotion, provision of publicity materials, and

providing a clearing-point for enquiries.– A peripatetic nurse can deliver checks for partners(eg. to

cover staff absence) – we re-charge for their time.

Lessons from practice

• Clinics and drop-ins– open access approach

• sometimes no-one comes (once 37 came)• use the time to talk to practice staff

– appointment approach• more predictable – better use of resources?• best where practice ‘owns’ promotion and

booking (some have our CSWs on their IT systems like their practice nurses)

Lessons from practice

• Health and Wellbeing Checks (HWBCs)– requires greater practice commitment– “being good for carers” is rarely enough

• evidence that it works• links to other targets and outcomes• a business case that pays for itself

– know the system, speak the language• ensure the LMC (and LPC) are in the loop• if you have connections – use them (eg. ex-NHS staff)• don’t compete with NHS comms. – feature in them

Lessons from practice

• Working with primary care – influence– some welcome us with open arms– some we are still pushing on the door

• don’t assume – some really don’t know about carers• do your homework – website, population, challenges• they really are all different – be flexible• be persistent but not annoying• a champion – whether receptionist, HCA or GP – is key

(identify the staff who are carers)

– keep knocking, smiling, and being astounded

Lessons from practice

• Working with primary care – final top tips– quick wins are there (point them out)

• “carers pick up prescriptions for others”• practices do mailings and newsletters• it doesn’t take much to put a link on a website (or to

make a simple referral slip for a GP to use)• regular reminders at practice meetings

– practices have constraints, just like us• some have windy stairs and not enough rooms• space is limited; make posters small• so is time; put them up yourself

Does it work?

• Much of our this work grew out of a successful DH Demonstrator Site programme:– The programme resulted in increased identification of

carers in participating practices and this has continued.– Carers reported better health and wellbeing as a result.

• We deliver services for carers in three quarters of our practices; we must be getting some of it right.• We are continually developing and improving, in

partnership with primary care and led by carers:– Measurement of outcomes has been further developed

and continues to show immediate and long-term benefits.

Thanks for listening!

Matthew Byrnem.byrne@westbankfriends.or

g08456 434 435

www.devoncarers.org.uk