Proactive Healthcare

For many UK adults, the days of easily accessing their GP is a distant memory. The strains on primary care systems limit the ability for regular contact with a consistent healthcare professional. Resulting in poorer health, reduced active lifestyles, higher degrees of frailty, increased hospital admissions and premature death. 

Although, for decades it has been evident that the UK population is ageing, we've neglecting to adjust our healthcare systems accordingly to meet the needs of the growing numbers of older adult. The 2021 consensus confirmed a 34% increase in over 65-year-olds within Hinckley & Bosworth, above the national average rise of 20%.  By 2045, the national number of over 85 year olds is expected to double,  thus we must begin to ask in its current form how will our healthcare systems cope? 

Around 90% of patient interaction in the NHS is with primary care. Yet, Leicestershire GP’s have experienced a 7% reduction in funding per patient since 2019, it is hardly surprising that 45% of older adults report concerns in their inability to access their GP. Likewise, GP patient surveys highlight poor satisfaction rates to be rising, with increasing proportions of older adults reporting they feel unsupported to manage their long-term conditions. Consequently, minor health concerns not alleviated by primary care evolve into more serious poor health states, resulting in older adults seeking assistance via 111 or emergency care in desperation. This can be highlighted in increasing numbers of Emergency department presentations or hospital admissions via ambulances, as after calling for an ambulance the likelihood of being taken into hospital increases with age. Current national Primary Care and Emergency Department figures making for stark reading:

•  Since the start of 2024, Primary care has around 30 million contacts with patients a month
• Around 40% of GP appointments take place on the same day as they are booked
• Only 65% of GP appointments are face to face.
• Around 45% of appointments are carried out by a GP & 20% by a nurse
• 26,000 ambulance calls daily in 2024, a 35% increase since 2020.
•  25.3 million Emergency Department attendances in 2023/24, a 18% increase since 2012.
• 46%  of hospital admissions are for over 65 years-olds & 23% were over 80 years-old. 
• 518,000 people waited more than 12 hours in an Emergency department in 2024. 
• Over 12 hour Emergency department waits increased by 25% since 2023 & 63% since 2019. 
• Warnings of Emergency Department waits linked to over 300 preventable deaths a week.

As the data figures confirms the NHS is already stretched to its absolute limit. Yet it is vital we understand that  1 in 5 older adult hospital admissions are deemed avoidable, a rate that raises to 40% of admissions for care home residents.  Consequently, a radical shift in the delivery of local and national older adult healthcare is not only priority but paramount for both patients & healthcare services.  Equally we must highlight the simple mechanisms which can reduce avoidable hospital admissions and maintain older adults health status.

For Example:

Around a 30% of over 65 year olds and 50% of over 85 year olds fall over each year in the UK. 

Falls not only cause pain or injury (1 in 20 will fracture a bone or need hospital), but also result in a loss of independence leading to a need for carers at home or even a care placement. Falls are also the leading cause of injury related to death in older adults (1 in 3 people with a hip fracture die within a year).  

Yet, targeted exercise regimes are reported to result in a 35% to 54% reduction in falls risks. 

Likewise,  the risk of a hospital admission or a fall increases with the number of medications an older adult takes. Adverse drug reaction related hospital admissions are estimated to be between 6% to 16%, although structured medication reviews have decreased in the community over the past few years.  In 2023/24 primary care witnessed a 22% drop in structured medication reviews (SMRs) for care home residents & a 25% reduction in SMRs for those living with severe frailty. But we know targeted SMRs in frail older adults can lead to a significant reduction risk of medicine harm and predicts a potential hospital admission avoidance rate for adverse drug related admissions of 85%*.

* Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance - The Pharmaceutical Journal