Devon carers health and wellbeing check Provider Guidance GP Practices

Devon carers health and wellbeing check
Provider Guidance GP Practices
14 November 2011
This document is intended to provide outline guidance to support a
consistent approach to undertaking health and wellbeing checks. Please
take the opportunity to include any further details under the goals section
based on past or current experience.
The carer has the right to determine what aspects of their health they wish
to concentrate on within the scope of the check. If there are issues that
make progress slow you may ask which areas they wish to concentrate on.
The carers health and wellbeing check is based on a self-care model of
delivery. Through the process however, an assessment should be made
about the appropriateness of sign-posting a carer to help. If the assessor
thinks the carer won’t follow up on essential actions, referrals should be
made for them with their consent.
Commencing the Check
The record of the check comprises an Individual Carer Record that is in 6
sections. This is also entered on a database after the consultation mainly
via check boxes and drop down lists. It is accessed via the following link
from GP practices and other NHS sites from 14 November 2011.
https://nww.devonpctinfo.nhs.uk/carers. Mandatory entry fields are
marked with an *.
Sections 1 and 2 – Background information
The carer should be invited to attend 10 minutes before the start of the
consultation to fill in the first two sections of ICR, see appendix.
Please complete section 1 – i.e. name and address etc, or at least GP (if
check is taking place in the Carer Practice) BEFORE giving to the carer.
Arrange with reception that when the carer arrives they will ask for the
carer’s booklet for the person doing the check to review (the carer may
choose not to hand over the booklet) and GIVE:
1. The Individual Carer Record ICR with verbal instructions to complete
sections 1 and 2.
2. Flashcard (for ethnicity and religion)
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The carer will now spend 5-10 minutes before the check appointment
starts filling out their ICR.
During this time the person doing the check may review the booklet the
carer has brought with them (if they have time) to aid them in guiding the
carer through the check. Otherwise, do this review quickly at the start of
the check.
Section 3 - Consent
This is to be completed with the carer during the check.
When the consultation starts, the person doing the check begins by
reviewing the partially completed ICR.
The leaflet ‘Your information, What you need to know’ should be handed
to them at this point and explained.
Consents are to be gained for
1) Storing/using information
2) Sharing with Care Direct Plus if a referral is needed.
Section 4 - Action planning
These are the same as the last pages of the booklet and are to be
completed at the end of the check when a clear sense of the priority
areas have been identified. They comprise tick boxes to trigger action, a
snapshot of general health and wellbeing and 3 goals. This section forms
the basis for the 6 monthly review .
Section 5 - Referral to Devon County Council adult services
Should the check result in a referral to social services, specifically the Care
Direct Plus team, section 5 should be completed outlining the carers
relevant background/current situation and your reason for referral. This is a
free text area but please cover details such as other caring responsibilities,
disabilities and relationship with the cared for to assist the hand over to a
new team. Please refer to the appendix page 13 and 14 to familiarise
yourself with eligibility criteria to avoid raising expectations.
Full contact details of care providers and voluntary organisations can be
found on the
Devon Care Directory at http://www.devonline.gov.uk/community/
Do not send page 5/Section 6 Vascular Check in your referral.
Section 6 – Vascular check
It is advised to undertake the vascular check at the beginning of the
consultation if the carer fits the criteria to ensure sufficient time is given to
the discussion. It is recorded on a separate sheet included at the end of
the ICR. If a referral to Devon County Council adult services is required this
page must not be sent to Care Direct.
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Literacy and translation
If a BME carer has a mentor with them and wishes the mentor to attend
during the consultation this should be facilitated. They will help the carer
and they will help you with language and issues that are culturally
sensitive.
Should you become aware of a carer who requires more than this
assistance, we have a support service for Black and Minority Ethnic Carers
and you can request a mentor to support a carer in preparing and
undertaking their check from the Sahara Service:
[email protected] 01392 314753.
Notes on use
1. The full record of the health and well-being check is held by the
carer in their booklet and subsequent review sheets. Please ensure
as the check progresses that anything important is noted.
2. This provider guidance document gives the thresholds and actions
for each question. Section 4 been designed to be completed
quickly and easily using mainly action recording.
3. Each line of this document corresponds to a question or questions in
the carers booklet 1 – 43.
4. The answers of yes and no may determine the need for action.
There is the opportunity for the carer to make any specific notes
under each section.
5. Work, education leisure MUST be raised with each carer.
6. As a general rule specific advice should mean referring to the GP for
consultation, more generic support should be signposted to the
Devon Virtual Carers Centre.
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Question and responses
The carer is invited to complete the HWBC booklet in advance of the check taking place. Most questions in the booklet
are a yes or no and this table outlines how to respond if necessary. Collectively this should inform the top three goals,
actions to achieve them and broad timing which will form part of the 6 month review.
Q’s
Aspect
1-11
Safety and warmth at home
Do you regularly use an open
fire, gas fire or wood burner?
Do you have floors in your
home without working smoke
alarms?
Does anyone smoke in the
house?
Are you worried that your
external doors are not
secure?
Can you identify a caller
before you open your front
door?
Have your ground floor
windows got key operated
window locks?
As a carer do you have
problems keeping warm in
winter?
Do you feel the house is cold
or draughty?
Threshol
d
Discussion
Goal setting
Yes
The Devon Safe at Home
service will provide a
handyperson to help you
indentify hazards at home
and can carry out small jobs
in up to two hours free time
which will make day to day
living easier and safer for you.
They can also refer you for
help with energy efficiency
measures and other home
improvement help which
may be available locally.
Receive a Home Safety
Assessment and access to Safe at
Home service
Yes
Yes
Yes
No
No
(excludes Plymouth, Torbay, neighbouring
counties)
Yes
Provide Safe at Home leaflet.
01271 340326 or 01271 341999
Yes
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Do you have concerns about
repairs to your house?
Are you able to get around
the house (each room
including the kitchen and
bathroom) easily?
Are you worried about any
other environmental risk?
Yes
No
Yes
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1214
Living and caring safely at home
Carer has not had or is not
receiving help and advice
but is in need of it
Q’s
1520
15
16
17
Yes to all
except
for No to
14b
Aspect
Discuss:
Care direct
Telecare products
DVCC and available training
(note that equipment can
come from many suppliers)
Through Caredirect – for
equipment via the equipment
prescription scheme
DVCC – access to training
Looking After Me – expert carers
programme 0800 0730792
St John Ambulance moving and
handling training
Goal setting
Threshol
d
Your own health and health care
Discussion
Is there anything about your
own health that worries you?
Yes
Discuss specifics in terms of:
Physical health
Emotional health
Ability to access work,
education or leisure
Book GP appointment to access
services e.g. psychological therapies
Is there any health related
advice you have received
that you haven’t followed
up?
Yes
Check that carer is able to attend
required appointments
Provide information re: DVCC take
a break scheme.
Contact DVCC to assess
replacement care
Are you taking four or more
Is replacement care required
for an immediate response?
Yes
Where carer lacks the confidence
to attend GP surgery
Access Community Mentoring Service
(or local Friends)
Check that carer has a had
Book GP appointment
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medicines?
18
Does your caring role
interfere with your sleep?
Yes
1920
Depression screen
Yes to
either
Q’s
Aspect
review in the last year
If no
Explore is this due to:
Lack of peace of mind
and/or caring tasks that need
to be performed
Ask if carer would like to
discuss this further with their
GP.
Discussion
Visit pharmacy to undertake a
Medicines Use Review (MUR)
Book GP appointment to access
services e.g. psychological therapies,
and/or contact DVCC to find out
what is available locally
Care Direct Plus
Book GP appointment to follow up
PQ9 assessment or equivalent.
Threshol
d
Some questions about check-ups, vaccinations and screenings
Goal setting
Dentist
Optician
Audiology
No
DVCC – access to sitting services
Register with dentist – 08450
220034
Dental access centres for
emergency work
Request flexible appointment time
GP practice appointment re:
hearing
22
Flu / pneumonia
No
23
Bowel cancer
No
2129
21
Explore possible reasons:
Not bothered
Not able due to caring
responsibilities
Not able due to not
registered with dentist
Not able due to cannot
afford (optician / dentist)
Not discussed with GP
(audiology)
DVCC – sitting services
Domiciliary visit needed?
Discuss importance
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DVCC – sitting service
Domiciliary visit
GP practice appointment –
vaccinations
Advise carer to participate in screening
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24
Cervical cancer
No
Discuss importance
25
Chlamydia
No
Discuss importance (if at risk)
26
Aortic aneurysm
No
27
In the last month have you
checked your skin for signs of
changes?
How often have you had 6 or
more units if female, or 8 or
more if male, on a single
occasion in the last year?
0 never
1 less than monthly
2 monthly
3 weekly
4 daily or almost daily
Yes
Follow standard operating
procedure guidelines
If necessary, refer to script in
appendix.
28
2936
29
30
31
32
This one M-SASQ question will determine
whether further assessment is needed
which should be performed by the GP.
If 0-1 – No further action
2-4 – further 9 M-SASQ questions to be
conducted by GP.
when invited.
DVCC – sitting service
Domiciliary visit
GP practice follow up
Family planning clinic follow up
STI clinic follow up
GP practice appointment for
further assessment of risk
Make an appointment with GP if
required
Provide Alcohol Brief advice tool
Refer to GP where a further
assessment will be undertaken
and further support can be
provided i.e. through Addaction
08451 302605
Al-anon for Family Groups who
provide support to anyone whose
life is, or has been, affected by
someone else’s drinking.
http://www.al-anonuk.org.uk/
Healthy lifestyle
Height
Weight
Waist measurement
5 portions of fruit and veg
Take measurement and note
in record. Cross check with
vascular check.
General discussion around
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Referral to GP if BMI over 30 or
carer concerned about weight.
Increasing physical activity
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33
34
35
36
37
37
Brisk exercise
Are you a smoker?
Yes
Would you like to stop
Yes
smoking?
Would you like someone to
Yes
contact you to help you give
up smoking?
Work, Education and Leisure
Does your caring role prevent you from
a) Pursuing employment
Yes
Aspect
3843
38
Caring roles and tasks
This doesn’t mean paid
employment only.
Explore with carer whether
there are opportunities for
them to change the situation
b) Pursuing education
opportunities;
c) Access to leisure activities
as you would wish to?
Q’s
Healthy lifestyle of 5 a day
and 150 mins of moderate
intensity exercise over a
week. Provide leaflets on
exercise and healthy eating.
Reviewing healthy eating
Stop smoking service or GP
Practice/Pharmacist
Contact Devon CVS for voluntary
work
DVCC will refer on to relevant
benefit entitlement advice.
Care direct plus – respite and
telecare
DVCC – training courses
Job Centre Plus to access Work Focused
Support for Carers scheme contact on
0800 05506688
Threshol
d
Discussion
Are there any caring tasks that you are currently undertaking that:
a) you would prefer not to
Yes
Are these:
be?
Practical – domestic
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Goal setting
Care Direct – information
Care Direct plus – for services
Page 9 of 17
39
40
41
42
43
b) you would like more skills or Yes
confidence in?
Emotional
Physical
Personal / intimate
Nursing tasks
Do you feel isolated from
your family and community
life
Do you feel your role as a
carer is acknowledged and
recognised?
Yes
Establish whether they are in
any support groups.
No
Discuss with carer who is
involved and encourage
assertiveness. “Looking After
Me” training is an option.
Discuss support needs and
the impact they are having
on the young person.
St John Ambulance - training
Make appointment with GP
Practice or speak to Complex
Care Team if they are known to
the carer.
Contact DVCC to access training
Contact DVCC to access training
such as “Looking After Me”
Contact DVCC to access training
such as “Looking After Me” or to
engage with support group
network
Contact DVCC to access Young
carers activity workers.
Is there a young person (up
Yes
to the age of 24) supporting
the care that you provide?
Is there a young person (up
Yes
to the age of 24) supporting
you to remain healthy and
well?
Do you require help with: BE CLEAR THIS IS APART FROM RESPITE/SOCIAL CARE INTERVENTION
Thinking about alternative
Yes
Emphasise importance of this Contact DVCC – contingency
care arrangements in the
and peace of mind it can
planning
event of an emergency?
bring.
Message in a bottle
Advanced Directive (end of life
care)
Moving and handling
Yes
If the person they care for has DVCC or care direct depending
critical or substantial needs
on cared for persons need.
then they will need to be
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Use of equipment and
adaptations
Yes
Nursing skills
Yes
Continence care
Yes
Managing challenging
behaviour
Yes
Caring for someone with
memory loss
Communication due to
sensory needs of the person
you care for
Understanding the condition
of the person you care for
Yes
Yes
Yes
signposted to care direct
where support will be
provided. Otherwise they can
be directed to DVCC for
advice and guidance.
Have they got the right
equipment?
Do they need training?
If yes then ask whether the
person they care for is
receiving support from health
and social care workers?
If they aren’t then signpost to
Care Direct
If they are then explore
whether they are happy with
the level of support and
signpost
This is condition specific and
advice should be sought
from either GP or DVCC
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Care direct for equipment
requests or DVCC for training if
appropriate
St John Ambulance carer support
programme
Refer to GP for Community Nursing
Continence Advisor support
Refer to GP or DVCC
Check if local memory clinics
available
Refer to GP or DVCC
Refer to GP or DVCC
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Pages 20 to 23 of the booklet are to be completed during the check with the carer. They are also entered into the ICR form under section 5.
They cover:
HWBC Wheel
The purpose of the wheel is to rate the carers current or perceived position across the 11 domains. It gives an at a
glance story at the point of the assessment.
My Personal Plan – Actions
Encourage the carer to identify those actions listed under this section to form a part of their action plan.
My Personal Plan – Goals
Encourage the carer to set goals. An approach could be using the SMART model (Specific, Measurable,
Achievable, Realistic, Timely) based on responses from the questions.
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Appendix
Skin cancer script
“In the last month, have you checked your skin for signs of changes?”
Yes / No
If yes:
“Well done, keep checking your skin regularly. It’s important because we
have very high rates of skin cancer in Devon, and the earlier that
melanoma can be diagnosed, the easier is it to treat.”
AND:
“Did you notice any changes? Many people have some moles or dark
patches on their skin that are flat or slightly raised. Usually these will remain
harmless all their life. But moles or patches of normal skin that change in
size, shape or colour over weeks or months in adult life should be shown to
your doctor. Show guidelines (ABCD). It’s better to be safe than sorry –
your GP won’t think you’re wasting their time, so book an appointment as
soon as possible. ”
If no: “It’s important to check your skin regularly for signs of changes using
these guidelines (show guidelines). Many people have some moles or dark
patches on their skin that are flat or slightly raised. Usually these will remain
harmless all their life. But moles or patches of normal skin that change in
size, shape or colour over weeks or months in adult life should be shown to
your doctor. It’s better to be safe than sorry – your GP won’t think you’re
wasting their time, so book an appointment as soon as possible if you
notice any changes.”
For more advice and resources, go to:
www.sunsmart.org.uk
www.swpho.nhs.uk/skincancerhub
http://www.devonpct.nhs.uk/Skin_cancer/Skin_Cancer_Prevention_Strate
gy_2011-14.aspx
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Clarification of referral processes to Devon County council adult
services arising from Carer Health and Wellbeing Checks
As a rule of thumb – only carers that have needs that cannot be met by
Devon Virtual Carers Centre would need to be signposted / referred to
Devon County Council Adult Services via Care Direct Plus. In particular if
they need more than three hours of sitting service a week to sustain their
caring role.
The Health Check training materials include summary sheets about Care
Direct (CD) and Care Direct Plus (CDP) and a briefing sheet on Fair Access
to Care Services (FACS) eligibility criteria. These provide the basic
description of social care support services available and how to access
them. They are also available on the Devon County Council Website.
The health and wellbeing check is based on a self-care model of delivery.
The goals agreed with the carer should focus on action that the carer
needs to take themselves, except in the case of a carer who needs
referral to adult services. The health care professional should use their
discretion about the amount of support the carer needs to achieve their
goals.
We also want to ensure that carers who are referred to adult services via
Care Direct Plus will be eligible for services (so that we do not raise
expectations and disappoint).
The health care professional providing the check should establish:
1. The carers needs cannot be met by Devon Virtual Carers Centre
2. The age and primary need of the person cared for.
If the referral is likely to result in the need to assess or review the needs of
the cared for person, the carer will need to ask permission from the cared
for person for this to happen before a CDP Advisor rings them back.
A referral can be made to adult services via Care Direct Plus from
anywhere in the County by sending a copy of the Individual Carer Record
(ICR) to:
Team Leaders: CDP North,
Care Direct Plus, St Georges Road,
Barnstaple,EX32 7AU.
Providers must ensure that section 6 on page 4 of the ICR is completed
with sufficient information about the carer’s situation, and a clear reason
why the referral is being made. This ensures the efficient handling of the
referral by CDP staff and avoids unnecessary duplication for the carer if
CDP staff are sufficiently briefed.
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The CDP Team Leader will contact the carer and establish the services
that may be required. If this results in a referral on to the Complex Care
Team (CCT), Learning Disability, Mental Health or Children’s Team
(depending on the urgency and complexity of needs of the cared for
person) the carer will be informed about the likely wait.
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Eligibility criteria check list for community care services
How the Eligibility Criteria are used
• The eligibility framework is graded into four bands, which describe
the seriousness of the risk to independence or other consequences if
needs are not addressed.
• Individual Eligibility Criteria within each band are only met where
there is no one else willing, able and appropriate who can
effectively manage the risks identified, and care services are
required.
• Evidence in the assessment or review that problems will develop or
occur should show that the problems will be inevitable or very likely.
• The emphasis should be to arrange short term interventions to
enable people to be independent where possible.
• Reviews need to be undertaken to help determine, amongst other
things, an individual’s continued eligibility for support.
Threshold for Care Services
The threshold for Devon County Council care services is for
• Critical and Substantial risks to be considered for care services, and
for
• Moderate and Low levels of risks to receive information and advice.
The four bands are as follows:
Critical - when
• Life is, or will be, threatened; and/or
• Significant health problems have developed or will develop; and/or
• There is, or will be, little or no choice and control over vital* aspects
of the immediate
• environment; and/or
• Serious abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out vital* personal care or
domestic routines;
• and/or
• Vital* involvement in work, education or learning cannot or will not
be sustained;
• and/or
• Vital* social support systems and relationships cannot or will not be
sustained;
• and/or
• Vital* family and other social roles and responsibilities cannot or will
not be undertaken.
*Vital - Definition
Vital aspects of a person's life or activities are those which, if they were not
able to continue, would result in one of the following:
•
Great risk of losing independence, and possibly making admission to
institutional care necessary.
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•
•
Great risk of only being able to make very little contribution to family and
wider community life, resulting in serious consequences for the individual or
others.
Great risk of making damaging and inappropriate contributions to family
life or the wider community, with serious consequences for the individual or
others.
What may be vital to one person may not be vital to another.
Substantial - when
• There is, or will be, only partial choice and control over the
immediate environment; and/or
• Abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out the majority of personal
care or domestic routines; and/or
• Involvement in many aspects of work, education or learning cannot
or will not be sustained; and/or
• The majority of social support systems and relationships cannot or will
not be sustained; and/or
• The majority of family and other social roles and responsibilities
cannot or will not be undertaken.
Moderate - when
• There is, or will be, an inability to carry out several personal care or
domestic routines; and/or
• Involvement in several aspects of work, education or learning
cannot or will not be sustained; and/or
• Several social support systems and relationships cannot or will not be
sustained; and/or
• Several family and other social roles and responsibilities cannot or
will not be undertaken.
Low - when
• There is, or will be, an inability to carry out one or two personal care
or domestic routines; and/or
• Involvement in one or two aspects of work, education or learning
cannot or will not be sustained; and/or
• One or two social support systems and relationships cannot or will
not be sustained; and/or
• One or two family and other social roles and responsibilities cannot
or will not be undertaken.
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