This article relates to the CQC key question: Is your practice effective? Is your practice caring? and Is your practice responsive to people's needs?
It is estimated that 10% of patients on a GP practice list are carers.
The responsibilities of carers mean they are more likely to suffer from ill health; through stress and depression, poor self-care or physical injuries due to incorrect moving and handling. Despite this, fewer than 10% of carers are identified by their GP practice and offered appropriate support.
Who are carers?
One of the reasons many carers are not identified by their GP practice is confusion around how to define term ‘carer’.
A carer is a person of any age (including children) who provides unpaid support to a partner, relative, friend or neighbour who couldn’t get by without their help. This could be due to old age, frailty, disability, a serious health condition, mental ill health or substance misuse. Parents of children who are disabled or who have a serious health condition are also considered to be carers.
There is a difference between a carer and a care worker or care assistant who is paid to provide care. This can be confusing, as some carers receive statutory payments (for example Carer’s Allowance) or a direct payment for their caring role. However, even when carers are in receipt of such payments, they are still considered to be carers.
As many practice teams know, carers may not readily identify with the label ‘carer’. Instead, they see themselves as someone’s partner, relative or friend who is simply 'doing their best' to help someone they care about. For this reason, the question 'Do you look after someone?'can be a more effective opening question than 'Are you a carer?'
What does good and outstanding care for carers look like?
Many organisations including the RCGP, Carers Trust, Carers UK and local commissioners have described initiatives practices can use to improve the care they give to carers. Some common themes include:
Improving carer identification:
There has been an increase in the number of people recorded as carers by their GP in the last year. Many practices have increased the number of people on their carers register by:
- Nominating a lead person for carers
- Asking patients with long term conditions to identify their carers
- Running awareness-raising campaigns to get carers to self-identify
Improving healthcare for carers:
- Flu vaccination:
- Most carers are eligible for a free flu vaccination to protect themselves and the person they care for. The PHE Green Book defines those eligible as: "Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Vaccination should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice."
- Recent figures from Public Health England show that vaccine uptake for carers identified by GP practices this year was 45.1%. There is significant scope for practices to improve their rates of flu vaccination for carers, as this figure is the percentage of patients registered as a carer by their GP practice and not the percentage of all carers. Estimates show that only 3% of all eligible carers actually receive their flu vaccine. Given the importance of protecting both carers and the people they care for from the flu, GP practices are strongly encouraged to identify the one in ten patients who are carers so that they can be offered the vaccine.
- Screening carers regularly for depression and other health problems
- Offering flexible appointments for carers.
Improving support for carers:
- Organising carer support groups or advice surgeries
- Organising surveys to gather carers’ feedback about services and their satisfaction with them
- Referrals to carers services for more specialised information, advice and support
What examples of outstanding care for carers have we already identified in our inspections?
Our inspectors have seen compassionate approaches to supporting carers in general practice. See these examples:
An urban practice with 3,600 patients:
The practice was proactive in its support for carers. For example, the computer system alerted GPs if a patient was a carer. The practice provided written information for carers to ensure they understood the various avenues of support available to them. The practice had links with a carer support worker and ran a carers group, which provided access to advice and information. This had resulted in the practice winning a local carers award for the support provided to carers in 2006.
A semi-rural practice with 9,500 registered patients:
The practice had a register of carers and a member of staff carried out the role of 'carers coordinator'. This staff member made annual contact with every carer on the register to ensure they were receiving the care and support they required. The carers register was then updated based on this contact.
A practice in a small town serving 14,000 registered patients:
The practice developed a carers group and worked with the Carers' Association to ensure patients received the most up to date support and guidance. The practice arranged a weekly session with the Carers Association to see carers (who may not necessarily be registered patients themselves). The practice made the room freely available because they recognised the benefits of this contact to the carers of their patients. The Carers Association worked with the practice to deliver a carers awareness evening to provide additional support to patients.
Carers Trust examples
Carers Trust has a range of best practice examples of outstanding care for carers. A recent case study provided by Herefordshire Carers Support, who have established a network of GP practice Carers Leads across the county, is below. In addition to increasing the number of carers identified and referred to their local carers service, the network has also encouraged practices to work collaboratively to support carers in the community:
'During Carers Week this year the Carers Leads from three practices worked together to hold an information event. All three surgeries contacted their carers and invited them to the event which featured speakers, info stands and Q&A sessions throughout the morning, ending with a speech by Baroness Jill Pithkeatly, the Herefordshire Carers Support Patron. It was a big success and a great example of surgeries working together to provide a service for their carers.'
Further guidance and resources
Resources for practices aiming to improve the care and support they offer for carers:
- RCGP carers support resources
- Carers Trust: GP practice quick start toolkit.
- Read more about how to make your practice carer-friendly on Medeconomics
Practices interested in support from their local carers service provider to help improve their care for carers can email Carers Trust’s primary care team at firstname.lastname@example.org
- Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection