Dr Julianaa Raghu  -  4 August 2023

My role

I am a SpR in Geriatric and General Medicine in South East London and have spent 2 years on an OOPE with the West Kent Home Treatment Service.

My reflection on community Geriatrics

Having spent all my training in the hospital, 2 years in the community was very daunting to begin with, but I have learnt so much in this role, skills which I can transfer into my training role in the hospital. I found that the risk at home is higher than in hospital and our patients are at risk wherever they are and therefore you have to carefully share this risk with the patient and their families, something I did not appreciate whilst in hospital. I learnt very quickly that the best patient care involves working closely with the acute hospitals. The care provided at home is more patient-centered as you are guided by the patient; however, in hospital they are put on a conveyor belt of investigations and patients can sometimes feel that they do not have a choice. In hospitals you have everything to hand but this is not the case in the community and you have to really rely on your clinical judgement to make decisions, something hospital training does not prepare you for. There are a lot of training opportunities with weekly huddles and you have the opportunity to train and support a wider workforce including the trainee Advanced Clinical Practioners.

The future

The unknown can be scary and actually having early exposure to community geriatrics is vital. I only knew about this service as I did this job as a CMT rotation so the exposure gave me an idea of what the job entailed. I feel that without early exposure it is difficult to recruit to the specialty.

The new geriatric curriculum has a lot of emphasis on community geriatrics and if it is a part of a 4–6-month rotation trainees can meet their curriculum requirements and do not have to do any extra time. This post could also be incorporated into the General Medicine Role and trainees will be able to get WBAs completed as it is still general medicine and trainees are still leading an acute unselected take.

As part of the NHS plan, every area should have an Urgent Care 2-hour response so the future workforce needs to be changing more towards the community. Consultants in the hospital are looking to the community for support and GPs are looking for the next step up for support. We are in demand, although it may not look like it.

I do not know what the answer is but, in my experience, I think if trainees had an early exposure to the specialty and it being mandatory, as a fixed rotation, then the workforce can be changed to be able to spend more time in the community.

In summary, community geriatrics not only involves reactive care but also has a focus on proactive care through which we raise the banner of preventative medicine and plan for the patient’s future care. It involves a lot of transferable skills between primary and secondary care and therefore provides a valuable experience for trainees whose training is primarily hospital-based. I have thoroughly enjoyed my 2 years with the West Kent Home Treatment Service and I cannot wait to utilise the skills I have learnt in my future ongoing career.