GP Extensivist Training Pilot in Dorset 2015-16
Two ‘GP Extensivist’ Fellowships have been piloted in Dorset from August 2015. Newly qualified GPs train for one year post-CCT with the elderly care teams in Poole and Bournemouth, but work broadly across hospital, GP and community multidisciplinary teams. There are currently no other Extensivist training programmes in the UK
Transitions between services provide a common trigger for suboptimal care. Information is lost at every handover and notes are an abbreviated version of the truth about a patient. Specialist doctors have necessarily become increasingly specialised but an ageing population leads our patients to become more complex with multiple interacting comorbidities. In the USA several healthcare providers have developed the role of Extensivist: an expert in managing patients with multiple (“extensive”) morbidities. The Extensivist initially manages patients in the community and becomes the lead physician during admissions, calling upon specialists as necessary. The Extensivist coordinates safe and timely discharge back to the community. For Caremore, this model reduced the number of hospital admissions and reduced the average length of hospital stays from eleven to four days.
The NHS Five Year Forward View and Roland Report recommend integrated care and team working across primary and secondary care. ‘Building the Workforce – the New Deal for General Practice’ recommends an extra training year in areas having difficulty recruiting trainees, to improve the breadth of training.
To produce Extensivists with appropriate skills our scheme supports a transfer of knowledge to bring the skills of hospital based geriatrician and community based generalist together, with additional understanding of the roles and potential of community teams.
We have produced a workplace based assessment tool by combining competencies from the RCGP and RCP geriatrics curricula, which is used for trainee self-rating and clinical supervisor assessment. (Our first trainee showed improvement in all 16 competencies during the first five months). Fellows report regularly on their experience, including what they have learnt, strengths and weaknesses of the post, recommendations on how ‘Extensivist’ training should be developed in future, and will summarize service development proposals made during the year. Fellows also sit the Diploma in Geriatric Medicine.
To date, Fellows have focused on: Admission prevention through work with GP surgeries and urgent outpatient services; Discharge processes such as “Discharge to assess”; Developing protocols supporting home management of conditions usually requiring admission. They have learnt how to develop business cases for service change to better meet patient needs.
The fellows have compiled many case vignettes which demonstrate, on a personal level, the benefit to patients, and on a systems level, the ability to prevent admissions and improve discharges.
The fellows share good practice with other extensivists, and are due to visit ‘Symphony’ Somerset CCG Vanguard site in Yeovil, the Health and Social care Hub in Weymouth and the SW New Forest Vanguard site.
We are in discussion regarding setting up a National forum for extensivists and developing a curriculum for extensivist training in collaboration with the RCGP and RCP Specialty Advisory Committee for Geriatric Medicine.