Background Our geographical area was identified as having a higher proportion of care home beds than average which results in a disproportionately high workload for primary care. A report in 2008 (Joseph Rowntree Foundation) noted that patients in UK care homes received nearly twice as many GP contacts as similar aged patients in the community. The Frailty Community Nurse Specialist service was implemented in April 2018 and has been funded for two years to support GP workload in care homes.

Aims of the service

• To support primary care;

• To initiate advance care planning and escalation plans;

• To review residents within 48 hours of admission;

• To improve confidence of care home staff through education and therefore reduce primary care contacts;

• To provide triage for minor illness/signpost care home staff to alternatives to GP by use of flowchart.

Method Initial scoping exercise of care home admissions, education needs and end of life care planning undertaken to develop clearer understanding of needs of care homes, patients and GPs. The visibility of the CNSs has ensured that they are the point of contact for advice and input/signposting, liaison with relatives regarding advance care planning including DNACPR (Do Not Attempt Cardio-pulmonary Resuscitation) and treatment escalation plans.

Results Feedback from both GP practices and care homes has been positive with the service seeing over 1000 residents within the first year. This has significantly improved both patient, carer and family experience as patients are able to remain within care homes with the support of the Frailty CNSs for end of life care.

Conclusion Initial results from the first year of service demonstrate a positive impact on GP workload, a reduction in A&E admissions and an increase in achievement of preferred place of care/death.