Community settings and intermediate care
Community geriatricians constitute the largest group of consultants working outside of the acute hospital. While some geriatricians are employed solely to work in community settings, many combine this role with sessions delivered within an acute trust. The British Geriatrics Society (BGS) recommends that any consultant post that is predominantly based in the community has close links with an affiliated hospital to prevent professional isolation and maintain continuing professional development (CPD) (see this case study of the Leeds interface geriatrician service, opens PDF, 249KB). Community geriatricians can be employed by acute trusts, community trusts, clinical commissioning groups and third sector organisations responsible for delivering community services.
Community geriatric medicine forms an important element of the healthcare of an older person living with frailty. The aim is to ensure that the person receives adequate and appropriate care within the community, whether in their own home or in a non-acute care setting such as a residential home or community hospital. Such services can help to reduce unnecessary admissions to hospital and also help people to be discharged from an acute setting in a timely fashion, to complete their care in a more appropriate environment.
By applying the principles of comprehensive geriatric assessment, community geriatricians work across boundaries within the health and social care system, crossing primary and secondary care, incorporating elements of public health in terms of health promotion, reablement and rehabilitation. This is achieved is by working where they are needed. For example, a geriatrician supports intermediate care and integrated local teams by providing input to multidisciplinary meetings, visiting patients when needed, and giving verbal advice. They work within community hospitals on wards and in outpatient clinics, and they support virtual wards. Community geriatricians work within care homes to improve the healthcare and services offered to their residents. This is not an exhaustive list.
- British Geriatrics Society Community Geriatrics Special Interest Group
- Leeds interface geriatrician service – case study of a community geriatrics service (opens PDF, 249KB)
- National Audit of Intermediate Care
- Making our health and care systems fit for an ageing population (opens PDF, 792.85KB)
- British Geriatrics Society Quest for Quality in Care Homes report and commissioning guidance
- NICE guidelines on Multimorbidity: clinical assessment and management
- British Geriatrics Society Fit for Frailty guidance
- NHS England Frail older people – Safe, compassionate care practical guidance