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A named clinician for every frail older person

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A named clinician for every frail older person A named clinician for every frail older person

On the 65th birthday of the NHS, the Secretary of State announced a new initiative for the support of the frail, older person to remain in their own homes and to avoid hospital admissions.

The initiative centres on all vulnerable, older people having a named clinician who would be accountable for their care. While the detail has still to be worked on, the named clinician is likely to be the GP.

Some GP practices never changed from a system of registration with a named GP for all their patients but the majority moved a decade ago to registration with the practice rather than with an individual GP. The initiative of the named GP is therefore not new but nevertheless very welcome and will provide comfort and reassurance for patients, their families and carers who currently struggle to understand who in the surgery is really 'in charge' of their care and understands the whole picture.

The proposal also provides an opportunity for the roles of both the practice nurse and the district nurse to be highlighted in supporting frail, older people and those with long-term conditions. The named GP will undoubtedly rely heavily on the whole-team approach when delegating his or her responsibility as the named clinician.

Practice nurses and district nurses are the experts in supporting patients and coordinating health and social care services to avoid hospital admissions wherever possible. District nurses in particular are the experts in the management of long-term conditions in older people and end-of-life care for those patients who are house bound and unable to attend the GP surgery.

The challenges will arise where the district nurse is working from a central provider office and not a GP surgery, where sharing of records and the ease of face-to-face communication in the team is impaired by geographical distance.

Co-location in the GP practice would provide an obvious solution. However, the related challenge will be ensuring that when the CCGs commission the co-located service, there are sufficient numbers of qualified district nurses in the system. It might just be the lever for increasing the numbers in specialist district nurse training so desperately needed.

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