Under the radar: General practitioners' experiences of directly employed care workers for older people

Abstract

The Care Act 2014 allows eligible people with care and support needs to access funding directly from local authorities in England. Such funds may be used to employ care workers. Others may employ care workers using their own or family resources. This study explores the working relationships, views and experiences of General Practitioner (GP) about older people's directly employed care workers (DECWs). Qualitative interviews were conducted with 20 GPs in England, identified by convenience sampling of research networks and snowballing methods. Data were analysed thematically. Three overarching themes were identified: (a) anxieties about the identity of the DECW, and their relationship to their employer; (b) experiences of relationship‐based care, and; (c) tasks carried out by DECWs. Identity mattered because DECWs can appear as an unknown participant in consultations, raising questions about consent, and prompting thoughts about elder abuse. Uncertainty about identity made documentation of DECWs' details in electronic medical records and care plans problematic. Case examples of relational care illustrated the benefits of reciprocity between older person and their employee who sometimes provided continuity of care and care co‐ordination for their employer. Participants were alert to the risks of exploitation and insecurity for DECWs whose tasks were thought to span household and personal care, transport assistance and health‐related activities. The involvement of DECWs in maintaining older people's health raises questions about the support they receive from health professionals. In conclusion DECWs are well placed to monitor older people's health, provide continuity of care and undertake certain healthcare tasks. GPs envisaged such workers as potentially valuable assets in community‐based care for an ageing population. They called for skills training for this workforce and the development of protocols for delegation of health tasks and safeguarding of vulnerable older people. Older people employing care workers and those advising or supporting them should address communications with health providers in employment contracts and job descriptions.

Caring in Covid-19: Personal Assistants’ Changing Relationships with their Clients’ Family Members

“…No PA seemed to be involved in their client's LA agreed support plan or any LA contingency planning. As Wilcock et al (2020) noted in a previous study of PAs' links with primary care, PAs are often unknown to such professionals unless they act in a role akin to family carers, making and attending appointments with their client, for example. Covid-19 has highlighted this lack of contact with wider LA and NHS services, leaving PAs, clients, and family members to negotiate ways of working.…”

‘You’re out on a limb, on your own’: Social care personal assistants’ (PAs’) reflections on working in the Covid-19 pandemic ‐ implications for wider health and care services

“…Further development of Personal Health Budgets (PHBs) (which are funded or partly funded by the NHS as well as social care) [ 30 – 32 ] could be considered as a way of assisting PAs to support employers to remain at home with more clinical oversight. Wilcock et al [ 33 ] undertook interviews with 20 General Practitioners (GPs) and flagged up tensions between their appreciation of potentially valuable PA role and skills, while at the same time experiencing anxieties about establishing their identities and relationship to their client. GPs therefore called for increased skills training for PAs and the development of protocols for delegation of health tasks and safeguarding of vulnerable people.…”