Guide to Supporting Carers in Primary Care

Co-production
Why support carers?
Cares in North Lincolnshire
How to talk to carers
How your practice can support carers
Tips on creating a Carer Friendly Culture
Coding carers for a Carers’ Register
The Practice Carer’s Charter
Websites with information for carers
Support for carers

Parent holding her disabled child who is smiling sat on the grass outside

A Guide for Health Care Practitioners: How to identify Carers and how to support them

The North Lincolnshire Guide to Supporting Carers has been co-developed with Carers, North Lincolnshire Council Carer Services and NHS England to raise awareness of carers within primary care, increase identification of Carers and ensure Carers are better supported.

The guide aims to give an overview of the benefits of supporting Carers, an overview of the different types of caring responsibilities and information around how best to talk to carers whilst sharing information on how to identify and record a Carer on System One.

It also discusses how best to connect Carers to support they may need or benefit from. Recognition of their caring role through the GP settings and connection to Carers specific support can make a significant difference to their physical and mental wellbeing.

Kath supports her husband who is diagnosed with dementia.

Carly adopted her children 10 years ago she is a Carer for two children and has spent some time being a sandwich Carer.

Created in co-production

This Practitioners Guide was developed through the Carers in Partnership Group and was coproduced by Carers Carly Sales and Kath Etheridge.

This Practitioners Guide aligns with NHS National guidance and has been developed from:

NHS England’s Quality Markers for unpaid Carers – this is a set of Markers and provides practical ideas on actions that can be taken to support Carers.
NICE Quality Standard on Supporting Adult Carers (QS200) helps improve the quality of care provided to adult Carers and supports better outcomes.
NICE quality standard should be read together with NICE Guideline on Supporting Adult Carers (NG150).

Two pairs of hands holding a paper cut out of a family

Why support Carers?

The Public Health Benefits of Supporting Carers

Carers can experience poor physical and mental health but could also have unmet care needs themselves. A paper from the University of Newcastle sets out the Public Health Benefits of supporting Carers and argues that a caring status should be a social determinant of health:

‘The findings from the GP Patient Survey analysis of Carers for any population, including those caring for older people, showed that Carers are at increased risk of illness, and specifically musculoskeletal conditions, cardiovascular disease, generalised cognitive deterioration and function, and poor sleep.’
‘Carers of older people can experience poor mental health, including anxiety and depression, alongside ‘Carer burden’, stress and poor quality of life.’
‘Young Carers are more likely to have worse educational attainment.’

Carers in North Lincolnshire

Definition: If you look after a family member, friend or neighbour with an illness or disability, mental health condition or addiction, unpaid, because they can’t manage day to day without your support, you are a Carer.

There are approximately 15,430 Carers in North Lincolnshire which equates to 9.6% per cent of the population.
Carers save nearly a billion pounds a year in North Lincolnshire alone.
North Lincolnshire Carers Strategy 2022-26 was coproduced with Carers to improve the experience and wellbeing of Carers.

Ken is an adult Carer who cares for his wife, Sue. She was diagnosed with Parkinson’s some years ago. The role for Ken has progressed over time and he has slowly taken on more in the house, as well as supporting Sue to keep well.

Lucy cares for her elderly parents and her young child who has cerebral palsy. She gives a lot of support both in and outside of her home. She is a sandwich or dual Carer.

Sophie was a young Carer for many years and now she is 18, she is a young adult Carer. When school finished, she found it easier to focus on caring for her dad and no longer accesses education or work. She also lost contact with a lot of friends

Jody is a parent Carer and cares for her two children who have complex learning disabilities and autism. She is currently juggling medical appointments and working alongside the school. The children present behaviour that is challenging and can be difficult to manage.

Josh is a young Carer. He supports mum in managing the household; cooking for his siblings and cleaning. He struggles to get his homework done as he has so much to do in the day.

How to talk to Carers

It’s good to remember:

It can be difficult to identify Carers as anyone can be a Carer and people move in and out of caring roles according to their circumstances.
Carers do not have any defining features and assumptions should not be made with regards to an individual’s attitudes towards their caring role.
It is important to be respectful in your approach.
The person that the Carer is caring for may not even be known to your team.
Carers often lose sight of their own needs and only focus on those for whom they are caring for.
Carers often want to continue to care for as long as possible.
Juggling the caring role and everyday life can be very overwhelming.
Carers tend to not see themselves as Carers, focussing on the relationship they have with the person, seeing themselves as wives, husbands, mothers etc.
Don’t assume that people looking after someone wants to do that caring role.

Woman walking arm in arm with her mother

Because Carers don’t see themselves as “Carers” it is helpful when approaching a discussion around their caring role to ask questions like:

“Are you managing OK?”
“Have things changed with…?”
“Do you need any support with…?”
“You seem to be providing a lot of support to…, would you like any help with…?”
“Is there anything I can do for you?”

It can be hard for Carers to accept help. Be prepared to repeat the offer of support at a later date.

Be mindful of cultural and religious issues at identification and try not to make assumptions around the nature of a person’s caring role due to the personal caring circumstances.

How your practice can support carers

Proactively Identify Carers – This should include the addition of the question ‘Do you provide support to someone who could not cope without your support?’ at all Annual Health Checks.
Information – All patients that identify as a Carer should be given information on support available in North Lincolnshire.  It is important to ensure that staff have training in the help that is available locally and ensure that they can signpost the Carer to other supporting agencies such as Carers Support.
Social Prescribing – All patients who identify as a Carer should also – with consent – be made aware of the social prescribing services available locally.
Offer a Carers Annual Wellbeing Check – The purpose of this check is to ensure that the information recorded on the Practice Carers Register is accurate and to provide a space where the Mental, Physical and Social aspects of the Carer’s life can be discussed. This should be included in other wellbeing checks as and when possible, e.g. age-related checks.

Immunisations – Carers are eligible for all routine immunisations. Details can be found here: Immunisation – GOV.UK (www.gov.uk)
Reasonable Adjustments – As much as possible, the team should consider actions to support Carers attending appointments. This could include extended appointments, combined appointments, the opportunity to have discussions away from the person they are caring for or virtual consultations.

Tips on creating a Carer Friendly Culture

Carers Register – should be kept through the coding of Carers in the Practice Electronic Patient Record. The benefits of a register is available on the CQC GP Myth Busters page.
Carers Champion – should be nominated in the practice. This worker can coordinate the work in the practice to improve the experience of Carers and act as a link with other workers in the system to improve the experience of Carers. The Carers’ Federation set out some ideas on the role of a Carers Champion.
Identify Carer Employees – working Carers in the Practice Team should also be offered the opportunity to self-identify and be given support.
Electronic Patient Records – should be used to alert staff that the patient is a Carer. This should follow on from a consistent process to code Carers as part of the creation of a Carers’ Register.

Made aware of Patient Participation Group – information on the PPG should be promoted by the Practice. Information/posters etc. are available from the Carers Support as highlighted in this pack.
Safeguarding – should there be safeguarding concerns with regards a Carer or the person being cared for, the named safeguarding lead in the Practice should be made aware and local processes followed.
Good practice on supporting Carers should be collated – it is recommended the Practice links in with the ICB/Regional and National Carers Team. This can be done by registering with National Commitment to Carers Team NHS Futures Platform.

Coding carers for a Carers’ Register

To keep an accurate Carers’ Register it is recommended that all carers are coded in electronic patient records.

Extract from GP Bulletin with information on recommended Carer Coding.

1. It is recommended that as a minimum data set Carers are coded as follows using one of the below SNOMED CT codes:

SNOMED CT code

224484003

Term Description

Patient themselves providing care.

Definition for NHS LTP delivery and associated metric

Person who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid.

302767002

Cares for a relative.

Person who looks after a family member who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid.

2. It is recommended that as appropriate Carers are coded as follows using the below SNOMED CT codes:

SNOMED CT code

1366321000000106

Term Description

Has Carer Contingency Plan/Has Carer Emergency Plan

Definition for NHS LTP delivery and associated metric

Carer has contingency plan in place for a situation when they cannot provide care and relevant information is accessible to professionals

The Practice Carer’s Charter

We will ensure that Carers are identified, they are coded as a Carer and a note is put on their records to enable all staff to recognise them as Carers.
We will take extra time and listen to the Carer at every point of contact, no matter which member of staff is involved.
All staff will recognise and value a Carer and respect the important role they fulfil. We will allow time to involve the Carer in the care of the person they support.
We will recognise the limitations of the support a Carer can give.
We will offer a longer appointment time or a combined appointment, if required, during a visit to the Practice.
This Guide will be displayed in appropriate places around the Practice.
Every Practice will deliver regular staff training to ensure that all staff are up to date with best practice when speaking to Carers. Carers Support and the CiP can assist with this.
Each Practice will nominate a Carer Champions whose role is to:
- Support Carers during their contact with the Practice
- Ensure the whole practice offers a Carer focused approach.