• Gnosall at the forefront still 20 September 2016 | View comments

  • I let Ian Greaves know that I had responded to an article in the BMJ which describes, from the vantage of academic service design, that there is need to bring services close to patients to achieve best use of resources and best outcomes. http://www.bmj.com/content/354/bmj.i4536

    My point was that the conclusions from design academia matches well with our experiences in Psychogeriatrics (aka Old Age Psychiatry) with development of social psychiatry teams working out from hospitals and into the community from the 1970s – Tom Arie and others leading the way. Lately the Gnosall model of a memory service within Primary Care has taken the model further, closer to the patient and family, since 2006.

    Ian’s response is to share with me the extraordinary range of new initiatives which are being woven into practice in Gnosall and other places: primary care is where it is all happening.

    Faced with austerity financial constraints and a shortage of trained professionals, necessity is doing what my mother told me it does – generating inventions.

    So Physician Assistants are back on an agenda which Ian (and I) were exploring almost 20 years ago. Nurses and Associate Nurses are being grown through apprenticeship schemes in primary care. People who have entered the workforce as Health Care Assistants or Domestic Workers are enabled to qualify as nurses: A workforce for a community from that community!

    Faced with the collapse of a Practice through retirement of the doctors, the response was to recruit Urgent Care Practitioners (e.g. http://www.careukhealthcare.com/healthcare-jobs/healthcare-professional-jobs/urgent-care-practitioner-paramedic-practitioner-north-east-essex-HC05641).

    In other situations Wellbeing Practitioners are employed to promote health and healthy life-styles http://www.iapt.nhs.uk/silo/files/psychological-wellbeing-practitioners--best-practice-guide.pdf

    Adrian O’Dowd has recently reviewed such initiatives in ‘Home run for integrated primary care?’ BMJ 2016: 353: i2922 doi: 10. 1136/bmj. I2922

    These developments are being explored in 70 centres and will be carefully controlled and evaluated. It is great to learn about new thinking and its application to counter gaps in the care system. It is frustrating that there is a mismatch between what the population needs and what the workforce and service structures prefer to do. New growth which matches and anticipates need is invigorating. Within this movement is a realisation that people are sensible and well educated and are keen to be helped to share responsibility for their own health – in its genesis and in coping when it breaks down in the face of pathology. First recourse for additional help will always be family. But there is a limit to what people can do without expert professional support and treatment.

    The essence of the Gnosall Memory Service is to bring Specialist Psychiatric Expertise into Primary Care – to work with GPs and other healthcare professionals to identify, treat and support people with dementia and related conditions and their families. The Elder Care Facilitator role works well because it is embedded in a competent professional team and the whole is known by and trusted by local people. This is not a question of ‘barefoot doctors’ out on their own and without highly qualified support and direction. It will be important that these new related models cultivate and nurture similar discipline and respect between their component parts.

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