The Care Pathway - Primary care

As you can see on this screen, primary care NHS services consist of at least a GP and a Practice Nurse. Nowadays primary care services tend to be broader and are based in health centres offering a number of clinics e.g. diabetes, asthma.

Pharmacists are increasingly used as sources of information and advice about health care and treatments including mental health.

There is effectively no social care equivalent to primary health care although ‘low level’ services offering practical help, such as shopping, housework, and garden maintenance are highly valued by older people. Increasingly, statutory agencies are withdrawing these services, even within a package of care.

Services that reduce isolation come under the ‘low level’ umbrella; isolation can lead to depression. These are sometimes provided by voluntary sector agencies such as Age Concern. Clubs such as the Derby and Joan also perform a social function.

You can explore these services now by clicking on each.

The Care Pathway - Primary care

(p>Although the prevalence of depression amongst older users of primary care is nearly double that of the general population, only around one in six are ever identified (Godfrey et al, 2005). In a typical Primary Care Trust area of 250,000 there will be 45,000 people (18%) who are aged 65 and over. Of these 2,250 will have dementia and 700 will have stroke related cognitive deficits (Care Services Improvement Partnership 2005). Dementia is associated with an annual incidence of 1.6 new patients per GP and a workload of 7.4 consultations per annum (Royal College of General Practitioners 1995)

Below are two case studies, Audrey and George.

Audrey

'I've always been a good sleeper even when my kids were young I could sleep through them crying and that. Well I was until about 18 months ago, when my husband Norman died; I started waking up in the night and then fretting about this and that and couldn't go off again. I could get to sleep alright, it was staying asleep... that was the trouble. Also I started to feel things weren't worth bothering with. I stopped seeing people and some days I didn't eat properly or go out when I knew there was something on. The Club I used to go to... they rang me once or twice but I said I was ill. My daughter took me to the doctor's and he said I was depressed. Well I’m not the sort to get depressed and I am not sure even now that I agree with him but anyway he put me on some tablets and quite soon after I did go back to the Club, met up with my old friends and started enjoying food again... I even started sleeping right through the night. That was such a relief! I feel much better now and I do think losing Norman and being alone too much was the cause of it....'.

George

'When I went to my GP I was diagnosed as having the early stages of Alzheimer's disease. While this was a terrible blow to both myself and my wife, we were glad to have been told so that we could discuss the possible effects on our lives and plan how we could adjust to the situation. I have made a will. I think it is important for the partner of the person with dementia to be fully informed of the diagnosis and possible effects since their life is affected quite dramatically. Fortunately for me, my wife is an intelligent and caring person with a strong personality. We have had 54 very happy years together and she is most supportive.'

Health Centres

These are buildings that house a range of primary care and related servcies. Most usually it contains GPs, primary care nurses and a number of other health professinals e.g. a dietician. Clinics are oftern offered for specific conditions such as ante-natal, asthma, strokes and diabetes. Health centres vary significantly in size and range of provision.

GPs

Most older people who have concerns about their memory or cognitive status go to see their GP. Early identification of dementia and depression are key policy priorities (Department of Health, 2001).

Dementia is routinely dealt with by primary care although there is considerable variation in GPs' skills in diagnosing and managing both dementia and depression (NICE/SCIE, 2006).

In a typical Primary Care Trust area of 250,000 there will be 2,250 patients with dementia; 700 others will have stroke related cognitive deficits. Dementia is associated with an annual workload of 7.4 consultations (Royal College of General Practitioners 1995). Once diagnosed, patients with dementia are long term and regular users of primary care services (England 2006).

Practice nurses

work in primary care providing assessment, screening, treatment, care and education to patients of all ages. Specifically, they provide advice, consultation and information about a range of health conditions and minor ailments; perform investigatory and routine procedures and minor operations; advise patients in respect of their continuing medical and nursing needs; and liaise with other health and social care professionals about ongoing care.

Pharmacists

(sometimes called Chemists) are experts in medicines and how they work. They play a key role in providing quality healthcare to patients. They dispense prescriptions, provide a range of services related to specific health issues and can offer advice on healthy living and minor ailments.