The district of Thanet has 61 care homes caring for around 1,500 residents. The area is served by an acute response team (ART) which was set up five years ago by Thanet GP Dr Ash Peshen, with the support of Oena Windibank, Local Care Director, East Kent CCGs, and Caroline Selkirk, Managing Director, East Kent CCGs, in partnership with the National Association of Primary Care. Its aim is to support care homes and the frail at home, including with end of life care, to enable people to come home from hospital with medical support or to avoid an unnecessary admission.

Providing medical support in the community

Dr Rakesh Koria, GP lead for the ART, explained: “The service utilises a team of GPs, nurses, paramedics, allied health care professionals and geriatricians in partnership with NHS acute and community trusts supporting holistic care in the community.

“We monitor the holistic and medical needs of frail patients in their own homes and care homes on a daily basis, offering appropriate input, and we also carry out remote hospital ward rounds and A&E assessments to find patients who are fit to go home but need follow-up medical surveillance or support.”

Additional service partners include Kent and Medway Clinical Commissioning Group, East Kent Hospital NHS Foundation Trust, Kent Community Health Foundation Trust (KCHFT), Thanet CIC, GPs and local voluntary sector organisations including Pilgrims Hospices, Age UK, Four Seasons social prescribing and care home colleagues.

New ways of working

“We knew early on, from looking at who the high-risk patients are, where the pressures would be,” said Rakesh. “As part of the COVID-19 response we’ve extended the ART hours from 8am – 5.30pm to 8am – 8pm. Instead of one GP working the full day, two GPs are covering shifts of 8am – 4pm and 12pm – 8pm, seven days a week.

“The team provides face-to-face assessments and responds to patients’ needs. We remain in touch daily with care homes and provide overall guidance on all aspects of medical care including isolation. This expanded service was further enhanced from Easter Friday with out of hours, end of life care GP support provided from 8pm to 8am across Kent and Medway CCG and this is still going strong, in partnership with our local out of hours providers IC24.” Dr Shelagh O’Riordan, Community Geriatrician and KCHFT Frailty Director in East Kent, has been leading in expanding this and similar services with enhancement across the rest of East Kent.

Consultant geriatrician Dr Upaasna Garbharran, working across acute and the community, supports the Thanet Care Homes team that co-ordinates communications to the care homes twice weekly, signposts challenges to the relevant clinical team and facilitates peer support and PPE mutual aid through WhatsApp. At the beginning of May there were many unwell care home residents and concerns about how well staff were coping. She rallied the acute response team and home visiting team to carry out comprehensive support via visits to help relieve the pressure, advising care homes on acute management as well as advanced care planning of patients and end of life care.

The service also provides medical support to a new 15-bed unit run by Kent Community Trust, set up to act as a step-down facility to help get patients out of hospital and as a step-up facility as needed.

Staff are also working more closely together. For example, care homes can ring the service if they are unable to get through to the GP surgery, or if district nurses need any medication changes for an end-of-life care patient they can call at any time.

There is also a new emphasis on ensuring treatment escalation plans are in place so that patients’ wishes can be followed.

Delivering change at speed

Rakesh believes that the uncertainty everyone felt watching the pandemic unfolding across the world was quite profound. “As health and care professionals, we had to work out how to protect patients by managing them at home and in the community,” he said. “We all started working with more collaboration, with a really different mindset emerging.”

A webinar is now held every Tuesday evening, allowing multi-disciplinary professionals to share knowledge very quickly. The first two attracted around 100 attendees and it is now open to health and care professionals across Kent and Medway.

Topics so far have included treatment escalation plans and end of life care drugs and how they differ for COVID-19 patients; complex patients and how to manage multiple deteriorating patients in care homes; and testing.

Rakesh said: “Together, we are sorting issues within days that have been unsolvable for many years. We hope that these new best practices – inspired by the crisis – are preserved for future shared working. We need to value each other and work together, giving everyone a sense of belonging. No one can do this without each other in these difficult times.”