We are both flexible trainees in geriatric medicine almost at the end of our speciality training. We have been fortunate to be involved in the background research, scoping work and the introduction of the Proactive Care of Older People Undergoing Surgery (POPS) at Darent Valley Hospital (a district general hospital in Kent). POPS is a service that was developed at Guy’s and St Thomas’ NHS Foundation Trust.
Older people have a lot to gain from surgery but are also at greater risk of post-operative complications, decline in their function and increased need for health and social care. POPS aims to address the challenges that face older people having to undergo surgery and improve their outcome.
This project has been an exceptional opportunity at this stage in our careers
The benefits of the service for older people have been demonstrated by research. POPS at GSTT have performed two research studies that have shown the POPS multidisciplinary intervention reduces length of stay and post-operative complications.
The service is increasingly gaining national and international recognition and a reputation as a gold standard of care. One challenge of service development has been how to translate a service provided at a large teaching hospital to a district general hospital in a financially viable and sustainable way.
This project has been an exceptional opportunity at this stage in our careers. It has enabled us to participate and be privy to management and executive decisions, for example in complex decision making on business cases and how to create a financially sustainable service for the future.
From a registrar’s perspective, it has been an excellent training opportunity and a very steep learning curve. The practical involvement in service development, business case writing and presentations at board levels has been both challenging and rewarding. Working across two sites and developing a service with the support and expertise of a larger established centre has been fantastic, and it has given us the framework to build the service on.
However, we have learned the importance of local contacts and contexts, developing a service around the existing structures which are already in place. Translating a service from a large foundation trust to a small district general hospital is indeed challenging. It needs to be developed to maintain the integrity of the service, whilst also fitting in, complementing the existing services and most importantly meeting the specific demands and requirements of the population it serves. Throughout the process patient and public engagement has been sought, enabling a locally relevant and patient-centred approach.
We have been fortunate to have strong links and contacts in both trusts, having worked in both organisations as trainees. This has certainly made collaborative working much easier. We have also spent significant energy and time in developing links and contacts in various areas from management, to finance and clinical departments.
Collaborative working across sites creates an exceptional opportunity to gain insight into different organisations to see what works and what doesn’t. This shared learning is invaluable.
Lastly, it is worth mentioning that it has been an absolute pleasure to be involved in a project that is improving patient care and challenging traditional working within the hospital. We feel really privileged to have been involved in this journey!
Catherine and Anna are ST7 level trainees in geriatrics and general internal medicine. They are currently working at Dartford and Gravesham NHS Trust. For further information about the POPS service please click here.