1. PRIMARY CARE MANAGEMENT

The work of the general practitioner increasingly involves the care of older people in partnership with the wider primary health care team, both within their own practice, in the local community, and also with specialists in secondary care, using the diagnostic and treatment resources available in hospitals.

• understanding of the theories of aging
• understanding of the physical, psychological and social changes that may occur with age and relating them to the adaptations which an older person makes, and to the breakdown of these adaptations
• understanding of the special factors associated with drug treatment e.g. the physiology of absorbtion, metabolism and excretion of drugs, the hazards posed by multiple prescribing, non-compliance and iatrogenic disease
• understanding of physical factors, particularly diet, exercise temperature and sleep which affect the health of older people
• understanding of the management of the conditions and problems commonly associated with old age such as Parkinson’s disease, falls, gait disorders, stroke, confusion etc.
• mastering an approach which allows easy access to the primary health care team for older people, appropriate timing of appointments and an organizational approach to the management of chronic conditions and co-morbidities

• knowledge of the locally agreed protocols for preventing and managing stroke
• understanding of the management of the transfer from the system of care to another, the complications that can arise and how they can be prevented and managed
• knowledge of the of different forms of residential accommodation available and the ability to advise patients about them
• knowledge of how to use the various statutory and voluntary organisations for support of older people in the community

• appropriate communication skills for counselling, teaching and treating patients, their families and carers recognising the difficulties of communicating with older patients including the slower tempo, possible unreliability and the evidence of third parties
• skills to develop policies for the primary care team so as to ensure effective management of repeat prescriptions, the appropriate use of screening and case finding programmes, auditing the quality of care of elderly people in all forms of residential accommodation

• the ability to develop and maintain a relationship, and a style of communication that treats the patient with respect, as an equal and does not patronise the patient
• ensuring that the provision of care promotes the patient’s sense of identity and personal dignity and that the patient is not discriminated against as a result of their age

Specific problem-solving skills

Focusing on problem-solving is a crucial part of GP training, because family doctors need to adopt a problem-based approach rather than a disease-based approach. This is particularly true when working with older people who often have complex physical, psychological and social problems.

The general practitioner should have the ability to;

Relate specific decision-making processes to the prevalence and incidence of illness in the community
This requires:
• knowledge of the prevalence and incidence of disease in the elderly population
• knowledge of the practice community (number of elderly patients, prevalence of chronic diseases)

To selectively gather and interpret information from history-taking, physical examination and investigations, and apply it to an appropriate management plan in collaboration with the patient
This requires:

• skills of taking a mental health assessment from an old person, including how to assess brain function (e.g. using short mental state questionnaires) and mood, and how to evaluate the testimony of third parties
• a willingness to involve the patient and if appropriate their carer and family in the management plan

To make effective and efficient use of diagnostic and therapeutic interventions
This requires:
• understanding of the changes in the normal range of laboratory values that are found in older people

By the end of training, the GP Registrar should understand the importance of:
• Treating children equitably and with respect for their beliefs, preferences, dignity and rights.
• Issues of confidentiality and consent
• Sharing information
• Record-keeping