array:67 [
"nid" => array:1 [
0 => array:1 [
"value" => "55446"
]
]
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0 => array:1 [
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]
]
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"value" => "56106"
]
]
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0 => array:1 [
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]
]
"type" => array:1 [
0 => array:3 [
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"langcode" => "en"
"status" => true
"dependencies" => array:1 [
"module" => array:2 [
0 => "menu_ui"
1 => "scheduler"
]
]
"third_party_settings" => array:2 [
"menu_ui" => array:1 [
"parent" => "main-menu:0:"
]
"scheduler" => array:10 [
"expand_fieldset" => "when_required"
"fields_display_mode" => "vertical_tab"
"publish_enable" => true
"publish_past_date" => "error"
"publish_required" => false
"publish_revision" => false
"publish_touch" => false
"unpublish_enable" => true
"unpublish_required" => false
"unpublish_revision" => false
]
]
"name" => "Resource"
"type" => "resource"
"description" => null
"help" => null
"new_revision" => true
"preview_mode" => 1
"display_submitted" => false
]
"bundle" => "node_type"
]
]
"revision_timestamp" => array:1 [
0 => array:1 [
"value" => "1732182382"
]
]
"revision_uid" => array:1 [
0 => array:3 [
"target_id" => "0"
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"uid" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"uuid" => array:1 [
0 => array:1 [
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]
]
"revision_id" => array:1 [
0 => array:1 [
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]
]
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0 => array:1 [
"value" => "en"
]
]
"preferred_langcode" => array:1 [
0 => array:1 [
"value" => "en"
]
]
"preferred_admin_langcode" => []
"name" => array:1 [
0 => array:1 [
"value" => ""
]
]
"pass" => []
"mail" => []
"timezone" => array:1 [
0 => array:1 [
"value" => ""
]
]
"status" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"created" => array:1 [
0 => array:1 [
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]
]
"changed" => array:1 [
0 => array:1 [
"value" => "1706607980"
]
]
"access" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"login" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"init" => []
"roles" => []
"default_langcode" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_default" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_translation_affected" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"metatag" => array:3 [
0 => array:2 [
"tag" => "meta"
"attributes" => array:2 [
"name" => "title"
"content" => "user | British Geriatrics Society"
]
]
1 => array:2 [
"tag" => "meta"
"attributes" => array:2 [
"name" => "description"
"content" => "British Geriatrics Society"
]
]
2 => array:2 [
"tag" => "link"
"attributes" => array:2 [
"rel" => "canonical"
"href" => "not yet assigned"
]
]
]
"role_change" => array:1 [
0 => array:1 [
"target_id" => "__role_delegation_empty_field_value__"
]
]
"revision_created" => array:1 [
0 => array:1 [
"value" => "1706607980"
]
]
"revision_user" => array:1 [
0 => array:3 [
"target_id" => "0"
"message" => "Recursion detected."
"array_path" => "revision_uid.0.entity"
]
]
"revision_log_message" => []
"path" => array:1 [
0 => array:1 [
"langcode" => "en"
]
]
"civicrm_contact_place_of_work" => array:1 [
0 => array:1 [
"" => ""
]
]
"civicrm_contact_region" => array:1 [
0 => array:1 [
"" => ""
]
]
"civicrm_contact_biography" => array:1 [
0 => array:1 [
"" => ""
]
]
"civicrm_contact_prefix" => array:1 [
0 => array:1 [
"" => ""
]
]
"civicrm_contact_job_title" => array:1 [
0 => array:1 [
"" => ""
]
]
"field_blog_subscribers" => []
"field_e_bulletin" => []
"field_events_e_bulletin_" => []
"field_legacy_id" => []
"field_member_alert" => []
"field_metatag" => []
"field_national_council_bulletin_" => []
"field_nurses_and_ahp_bulletin" => []
"field_privacy_statement" => []
"field_region_bulletin_" => []
"field_sig_and_section_bulletins_" => []
"field_special_interest_groups" => []
"field_sponsored_e_bulletin" => []
"field_trainees_bulletin_" => []
"user_picture" => []
]
"bundle" => "user"
]
]
"revision_log" => []
"status" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"uid" => array:1 [
0 => array:3 [
"target_id" => "14122"
"entity" => array:46 [
"uid" => array:1 [
0 => array:1 [
"value" => "14122"
]
]
"uuid" => array:1 [
0 => array:1 [
"value" => "17c65cc6-2224-4427-9b62-68a46e795414"
]
]
"revision_id" => array:1 [
0 => array:1 [
"value" => "84032"
]
]
"langcode" => array:1 [
0 => array:1 [
"value" => "en"
]
]
"preferred_langcode" => array:1 [
0 => array:1 [
"value" => "en"
]
]
"preferred_admin_langcode" => []
"name" => array:1 [
0 => array:1 [
"value" => "Amy Brewerton"
]
]
"pass" => array:1 [
0 => array:1 [
"value" => "$2y$10$Q4XqfSgxpzwcU7WTUs6iX.9tXvemS3JrPIWGVJbY/dUH173.AMAky"
]
]
"mail" => array:1 [
0 => array:1 [
"value" => "publishing@bgs.org.uk"
]
]
"timezone" => array:1 [
0 => array:1 [
"value" => "Europe/London"
]
]
"status" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"created" => array:1 [
0 => array:1 [
"value" => "1707470552"
]
]
"changed" => array:1 [
0 => array:1 [
"value" => "1729758232"
]
]
"access" => array:1 [
0 => array:1 [
"value" => "1731926930"
]
]
"login" => array:1 [
0 => array:1 [
"value" => "1731926187"
]
]
"init" => []
"roles" => array:6 [
0 => array:3 [
"target_id" => "member"
"entity" => array:9 [
"uuid" => "ae48c1c2-722e-4c10-82a8-7859afad1f5d"
"langcode" => "en"
"status" => true
"dependencies" => array:1 [
"module" => array:1 [ …1]
]
"id" => "member"
"label" => "Member"
"weight" => 2
"is_admin" => null
"permissions" => array:3 [
0 => "access comments"
1 => "access user profiles"
2 => "post comments"
]
]
"bundle" => "user_role"
]
1 => array:3 [
"target_id" => "administrator"
"entity" => array:10 [
"uuid" => "2a4bc869-22a5-4c08-ae59-8014c0cf8bd0"
"langcode" => "en-gb"
"status" => true
"dependencies" => []
"_core" => array:1 [
"default_config_hash" => "OeKGIkmZA_c-t6QLH81WNQx8gDCc1MRmxaTuQgxBByU"
]
"id" => "administrator"
"label" => "Administrator"
"weight" => 3
"is_admin" => true
"permissions" => []
]
"bundle" => "user_role"
]
2 => array:3 [
"target_id" => "website_editor"
"entity" => array:9 [
"uuid" => "14d4b835-9f76-4781-b7ef-f1b1fc2eec0a"
"langcode" => "en"
"status" => true
"dependencies" => array:2 [
"config" => array:17 [ …17]
"module" => array:9 [ …9]
]
"id" => "website_editor"
"label" => "Website editor"
"weight" => 4
"is_admin" => null
"permissions" => array:73 [
0 => "access administration pages"
1 => "access content"
2 => "access content overview"
3 => "access toolbar"
4 => "access user profiles"
5 => "bypass honeypot protection"
6 => "create blog content"
7 => "create event content"
8 => "create external_course content"
9 => "create external_event content"
10 => "create external_jobs content"
11 => "create form content"
12 => "create member_update content"
13 => "create news content"
14 => "create paragraph content attachment"
15 => "create paragraph content attachments"
16 => "create paragraph content faqs"
17 => "create paragraph content faqs_accordion"
18 => "create paragraph content links"
19 => "create paragraph content quote"
20 => "create paragraph content team"
21 => "create paragraph content video"
22 => "create paragraph content wysiwyg"
23 => "create policy_update content"
24 => "create publication content"
25 => "create resource content"
26 => "create resource_series content"
27 => "create webform content"
28 => "delete any event content"
29 => "delete any form content"
30 => "delete any publication content"
31 => "delete any webform content"
32 => "delete paragraph content attachment"
33 => "delete paragraph content attachments"
34 => "delete paragraph content faqs"
35 => "delete paragraph content faqs_accordion"
36 => "delete paragraph content link_flexi"
37 => "delete paragraph content links"
38 => "delete paragraph content q_a"
39 => "delete paragraph content team"
40 => "delete paragraph content video"
41 => "edit any blog content"
42 => "edit any event content"
43 => "edit any external_jobs content"
44 => "edit any form content"
45 => "edit any news content"
46 => "edit any policy_update content"
47 => "edit any publication content"
48 => "edit any resource content"
49 => "edit any system_page content"
50 => "edit any webform content"
51 => "edit own external_course content"
52 => "edit own external_event content"
53 => "schedule publishing of nodes"
54 => "search content"
55 => "update paragraph content attachment"
56 => "update paragraph content attachments"
57 => "update paragraph content faqs"
58 => "update paragraph content faqs_accordion"
59 => "update paragraph content links"
60 => "update paragraph content q_a"
61 => "update paragraph content quote"
62 => "update paragraph content team"
63 => "update paragraph content video"
64 => "update paragraph content wysiwyg"
65 => "use admin toolbar search"
66 => "use advanced search"
67 => "use text format filtered_html"
68 => "use text format full_html"
69 => "use text format title"
70 => "view own unpublished content"
71 => "view scheduled content"
72 => "view the administration theme"
]
]
"bundle" => "user_role"
]
3 => array:3 [
"target_id" => "web_admininstrator"
"entity" => array:9 [
"uuid" => "15898fd0-081b-4594-a523-c4cd7df979e6"
"langcode" => "en"
"status" => true
"dependencies" => array:2 [
"config" => array:29 [ …29]
"module" => array:10 [ …10]
]
"id" => "web_admininstrator"
"label" => "Web admininstrator"
"weight" => 5
"is_admin" => null
"permissions" => array:116 [
0 => "access administration pages"
1 => "access comments"
2 => "access content overview"
3 => "access user profiles"
4 => "access users overview"
5 => "administer comments"
6 => "administer nodes"
7 => "administer users"
8 => "bypass honeypot protection"
9 => "create blog content"
10 => "create country content"
11 => "create event content"
12 => "create external_event content"
13 => "create external_jobs content"
14 => "create group content"
15 => "create member_update content"
16 => "create news content"
17 => "create page content"
18 => "create person content"
19 => "create policy_update content"
20 => "create promo content"
21 => "create publication content"
22 => "create resource content"
23 => "create resource_series content"
24 => "create simpleads content"
25 => "create slide content"
26 => "create team content"
27 => "create url aliases"
28 => "create users"
29 => "create vimeo_stream content"
30 => "create voting_form content"
31 => "delete any blog content"
32 => "delete any country content"
33 => "delete any elearning_module content"
34 => "delete any event content"
35 => "delete any external_course content"
36 => "delete any external_event content"
37 => "delete any external_jobs content"
38 => "delete any group content"
39 => "delete any member_update content"
40 => "delete any news content"
41 => "delete any page content"
42 => "delete any person content"
43 => "delete any policy_update content"
44 => "delete any promo content"
45 => "delete any publication content"
46 => "delete any resource content"
47 => "delete any resource_series content"
48 => "delete any simpleads content"
49 => "delete any slide content"
50 => "delete any team content"
51 => "delete any vimeo_stream content"
52 => "delete any voting_form content"
53 => "delete any webform content"
54 => "delete own blog content"
55 => "delete own elearning_module content"
56 => "delete own external_course content"
57 => "delete own external_event content"
58 => "delete own group content"
59 => "delete own member_update content"
60 => "delete own news content"
61 => "delete own policy_update content"
62 => "delete own resource content"
63 => "delete own resource_series content"
64 => "delete own simpleads content"
65 => "delete own voting_form content"
66 => "delete own webform content"
67 => "edit any blog content"
68 => "edit any country content"
69 => "edit any elearning_module content"
70 => "edit any event content"
71 => "edit any external_course content"
72 => "edit any external_event content"
73 => "edit any external_jobs content"
74 => "edit any form content"
75 => "edit any front content"
76 => "edit any group content"
77 => "edit any member_update content"
78 => "edit any news content"
79 => "edit any page content"
80 => "edit any person content"
81 => "edit any policy_update content"
82 => "edit any promo content"
83 => "edit any publication content"
84 => "edit any resource content"
85 => "edit any resource_series content"
86 => "edit any simpleads content"
87 => "edit any slide content"
88 => "edit any system_page content"
89 => "edit any team content"
90 => "edit any vimeo_stream content"
91 => "edit any voting_form content"
92 => "edit any webform content"
93 => "edit own blog content"
94 => "edit own elearning_module content"
95 => "edit own external_course content"
96 => "edit own external_event content"
97 => "edit own group content"
98 => "edit own member_update content"
99 => "edit own news content"
100 => "edit own policy_update content"
101 => "edit own resource content"
102 => "edit own resource_series content"
103 => "edit own simpleads content"
104 => "edit own voting_form content"
105 => "edit own webform content"
106 => "masquerade as any user"
107 => "post comments"
108 => "schedule publishing of nodes"
109 => "use advanced search"
110 => "use text format filtered_html"
111 => "use text format full_html"
112 => "use text format title"
113 => "view own unpublished content"
114 => "view scheduled content"
115 => "view the administration theme"
]
]
"bundle" => "user_role"
]
4 => array:3 [
"target_id" => "bgs_civi_administrator"
"entity" => array:9 [
"uuid" => "f978bdf6-7688-4e61-8cb0-2e81df532e91"
"langcode" => "en"
"status" => true
"dependencies" => array:2 [
"config" => array:27 [ …27]
"module" => array:24 [ …24]
]
"id" => "bgs_civi_administrator"
"label" => "BGS civi administrator"
"weight" => 6
"is_admin" => null
"permissions" => array:174 [
0 => "access administration pages"
1 => "access content"
2 => "access content overview"
3 => "access contextual links"
4 => "access devel information"
5 => "access security review list"
6 => "access site in maintenance mode"
7 => "access site reports"
8 => "access user profiles"
9 => "access users overview"
10 => "add JS snippets for google analytics"
11 => "administer content types"
12 => "administer devel menu items"
13 => "administer fitvids"
14 => "administer google analytics"
15 => "administer languages"
16 => "administer login destination settings"
17 => "administer menu"
18 => "administer modules"
19 => "administer nodes"
20 => "administer pathauto"
21 => "administer permissions"
22 => "administer redirects"
23 => "administer scheduler"
24 => "administer search"
25 => "administer shortcuts"
26 => "administer site configuration"
27 => "administer software updates"
28 => "administer taxonomy"
29 => "administer themes"
30 => "administer url aliases"
31 => "administer users"
32 => "administer views"
33 => "administer xmlsitemap"
34 => "assign all roles"
35 => "bypass node access"
36 => "cancel account"
37 => "change own username"
38 => "create blog content"
39 => "create country content"
40 => "create event content"
41 => "create external_course content"
42 => "create external_event content"
43 => "create form content"
44 => "create front content"
45 => "create group content"
46 => "create member_update content"
47 => "create news content"
48 => "create page content"
49 => "create person content"
50 => "create policy_update content"
51 => "create promo content"
52 => "create publication content"
53 => "create resource content"
54 => "create resource_series content"
55 => "create slide content"
56 => "create system_page content"
57 => "create team content"
58 => "create url aliases"
59 => "create users"
60 => "create voting_form content"
61 => "customize shortcut links"
62 => "delete any blog content"
63 => "delete any country content"
64 => "delete any elearning_module content"
65 => "delete any event content"
66 => "delete any external_course content"
67 => "delete any external_event content"
68 => "delete any form content"
69 => "delete any front content"
70 => "delete any group content"
71 => "delete any member_update content"
72 => "delete any news content"
73 => "delete any page content"
74 => "delete any person content"
75 => "delete any policy_update content"
76 => "delete any promo content"
77 => "delete any publication content"
78 => "delete any resource content"
79 => "delete any resource_series content"
80 => "delete any slide content"
81 => "delete any system_page content"
82 => "delete any team content"
83 => "delete any voting_form content"
84 => "delete any webform content"
85 => "delete own blog content"
86 => "delete own country content"
87 => "delete own elearning_module content"
88 => "delete own event content"
89 => "delete own external_course content"
90 => "delete own external_event content"
91 => "delete own form content"
92 => "delete own front content"
93 => "delete own group content"
94 => "delete own member_update content"
95 => "delete own news content"
96 => "delete own page content"
97 => "delete own person content"
98 => "delete own policy_update content"
99 => "delete own promo content"
100 => "delete own publication content"
101 => "delete own resource content"
102 => "delete own resource_series content"
103 => "delete own slide content"
104 => "delete own system_page content"
105 => "delete own team content"
106 => "delete own user revisions"
107 => "delete own voting_form content"
108 => "delete own webform content"
109 => "edit any blog content"
110 => "edit any country content"
111 => "edit any elearning_module content"
112 => "edit any event content"
113 => "edit any external_course content"
114 => "edit any external_event content"
115 => "edit any form content"
116 => "edit any front content"
117 => "edit any group content"
118 => "edit any member_update content"
119 => "edit any news content"
120 => "edit any page content"
121 => "edit any person content"
122 => "edit any policy_update content"
123 => "edit any promo content"
124 => "edit any publication content"
125 => "edit any resource content"
126 => "edit any resource_series content"
127 => "edit any slide content"
128 => "edit any system_page content"
129 => "edit any team content"
130 => "edit any voting_form content"
131 => "edit any webform content"
132 => "edit own blog content"
133 => "edit own country content"
134 => "edit own elearning_module content"
135 => "edit own event content"
136 => "edit own external_course content"
137 => "edit own external_event content"
138 => "edit own form content"
139 => "edit own front content"
140 => "edit own group content"
141 => "edit own member_update content"
142 => "edit own news content"
143 => "edit own page content"
144 => "edit own person content"
145 => "edit own policy_update content"
146 => "edit own promo content"
147 => "edit own publication content"
148 => "edit own resource content"
149 => "edit own resource_series content"
150 => "edit own slide content"
151 => "edit own system_page content"
152 => "edit own team content"
153 => "edit own voting_form content"
154 => "edit own webform content"
155 => "masquerade as any user"
156 => "masquerade as super user"
157 => "notify of path changes"
158 => "revert own user revisions"
159 => "run security checks"
160 => "schedule publishing of nodes"
161 => "search content"
162 => "select account cancellation method"
163 => "switch shortcut sets"
164 => "switch users"
165 => "use advanced search"
166 => "use text format ds_code"
167 => "use text format filtered_html"
168 => "use text format full_html"
169 => "use text format title"
170 => "view own unpublished content"
171 => "view own user revisions"
172 => "view scheduled content"
173 => "view the administration theme"
]
]
"bundle" => "user_role"
]
5 => array:3 [
"target_id" => "bgs_admin"
"entity" => array:9 [
"uuid" => "66d8f893-6e9e-4d75-817e-01586d8df27e"
"langcode" => "en"
"status" => true
"dependencies" => array:2 [
"config" => array:31 [ …31]
"module" => array:6 [ …6]
]
"id" => "bgs_admin"
"label" => "BGS admin"
"weight" => 30
"is_admin" => null
"permissions" => array:391 [
0 => "access content"
1 => "access content overview"
2 => "access user profiles"
3 => "access users overview"
4 => "administer nodes"
5 => "administer users"
6 => "allow empty user mail"
7 => "bypass paragraphs type content access"
8 => "cancel account"
9 => "cancel users by role"
10 => "change own username"
11 => "create admin_help_page content"
12 => "create blog content"
13 => "create country content"
14 => "create elearning_module content"
15 => "create event content"
16 => "create external_course content"
17 => "create external_event content"
18 => "create external_jobs content"
19 => "create faq content"
20 => "create form content"
21 => "create front content"
22 => "create group content"
23 => "create landing_page content"
24 => "create member_update content"
25 => "create news content"
26 => "create page content"
27 => "create paragraph content attachment"
28 => "create paragraph content attachments"
29 => "create paragraph content block"
30 => "create paragraph content call_to_action"
31 => "create paragraph content faqs"
32 => "create paragraph content faqs_accordion"
33 => "create paragraph content feed"
34 => "create paragraph content form"
35 => "create paragraph content from_library"
36 => "create paragraph content gallery"
37 => "create paragraph content hero_card"
38 => "create paragraph content home_featured_events"
39 => "create paragraph content home_featured_items"
40 => "create paragraph content home_latest"
41 => "create paragraph content iframe"
42 => "create paragraph content link_flexi"
43 => "create paragraph content links"
44 => "create paragraph content links_flexi_container"
45 => "create paragraph content map_world"
46 => "create paragraph content promo"
47 => "create paragraph content q_a"
48 => "create paragraph content quote"
49 => "create paragraph content slider"
50 => "create paragraph content social_links"
51 => "create paragraph content stream_day"
52 => "create paragraph content stream_session"
53 => "create paragraph content tagged"
54 => "create paragraph content team"
55 => "create paragraph content team_member"
56 => "create paragraph content twitter"
57 => "create paragraph content video"
58 => "create paragraph content view"
59 => "create paragraph content wysiwyg"
60 => "create person content"
61 => "create policy_update content"
62 => "create publication content"
63 => "create resource content"
64 => "create resource_series content"
65 => "create simpleads content"
66 => "create slide content"
67 => "create system_page content"
68 => "create team content"
69 => "create users"
70 => "create vimeo_stream content"
71 => "create voting_form content"
72 => "create webform content"
73 => "delete admin_help_page revisions"
74 => "delete any admin_help_page content"
75 => "delete any blog content"
76 => "delete any country content"
77 => "delete any elearning_module content"
78 => "delete any event content"
79 => "delete any external_course content"
80 => "delete any external_event content"
81 => "delete any external_jobs content"
82 => "delete any faq content"
83 => "delete any form content"
84 => "delete any front content"
85 => "delete any group content"
86 => "delete any landing_page content"
87 => "delete any member_update content"
88 => "delete any news content"
89 => "delete any page content"
90 => "delete any person content"
91 => "delete any policy_update content"
92 => "delete any promo content"
93 => "delete any publication content"
94 => "delete any resource content"
95 => "delete any resource_series content"
96 => "delete any simpleads content"
97 => "delete any slide content"
98 => "delete any system_page content"
99 => "delete any team content"
100 => "delete any vimeo_stream content"
101 => "delete any voting_form content"
102 => "delete any webform content"
103 => "delete blog revisions"
104 => "delete country revisions"
105 => "delete elearning_module revisions"
106 => "delete event revisions"
107 => "delete external_course revisions"
108 => "delete external_event revisions"
109 => "delete external_jobs revisions"
110 => "delete faq revisions"
111 => "delete form revisions"
112 => "delete front revisions"
113 => "delete group revisions"
114 => "delete landing_page revisions"
115 => "delete member_update revisions"
116 => "delete news revisions"
117 => "delete own admin_help_page content"
118 => "delete own blog content"
119 => "delete own country content"
120 => "delete own elearning_module content"
121 => "delete own event content"
122 => "delete own external_course content"
123 => "delete own external_event content"
124 => "delete own external_jobs content"
125 => "delete own faq content"
126 => "delete own form content"
127 => "delete own front content"
128 => "delete own group content"
129 => "delete own landing_page content"
130 => "delete own member_update content"
131 => "delete own news content"
132 => "delete own page content"
133 => "delete own person content"
134 => "delete own policy_update content"
135 => "delete own promo content"
136 => "delete own publication content"
137 => "delete own resource content"
138 => "delete own resource_series content"
139 => "delete own simpleads content"
140 => "delete own slide content"
141 => "delete own system_page content"
142 => "delete own team content"
143 => "delete own vimeo_stream content"
144 => "delete own voting_form content"
145 => "delete own webform content"
146 => "delete page revisions"
147 => "delete paragraph content attachment"
148 => "delete paragraph content attachments"
149 => "delete paragraph content block"
150 => "delete paragraph content call_to_action"
151 => "delete paragraph content faqs"
152 => "delete paragraph content faqs_accordion"
153 => "delete paragraph content feed"
154 => "delete paragraph content form"
155 => "delete paragraph content from_library"
156 => "delete paragraph content gallery"
157 => "delete paragraph content hero_card"
158 => "delete paragraph content home_featured_events"
159 => "delete paragraph content home_featured_items"
160 => "delete paragraph content home_latest"
161 => "delete paragraph content iframe"
162 => "delete paragraph content link_flexi"
163 => "delete paragraph content links"
164 => "delete paragraph content links_flexi_container"
165 => "delete paragraph content map_world"
166 => "delete paragraph content promo"
167 => "delete paragraph content q_a"
168 => "delete paragraph content quote"
169 => "delete paragraph content slider"
170 => "delete paragraph content social_links"
171 => "delete paragraph content stream_day"
172 => "delete paragraph content stream_session"
173 => "delete paragraph content tagged"
174 => "delete paragraph content team"
175 => "delete paragraph content team_member"
176 => "delete paragraph content twitter"
177 => "delete paragraph content video"
178 => "delete paragraph content view"
179 => "delete paragraph content wysiwyg"
180 => "delete person revisions"
181 => "delete policy_update revisions"
182 => "delete promo revisions"
183 => "delete publication revisions"
184 => "delete resource revisions"
185 => "delete resource_series revisions"
186 => "delete simpleads revisions"
187 => "delete slide revisions"
188 => "delete system_page revisions"
189 => "delete team revisions"
190 => "delete vimeo_stream revisions"
191 => "delete voting_form revisions"
192 => "delete webform revisions"
193 => "edit any admin_help_page content"
194 => "edit any blog content"
195 => "edit any country content"
196 => "edit any elearning_module content"
197 => "edit any event content"
198 => "edit any external_course content"
199 => "edit any external_event content"
200 => "edit any external_jobs content"
201 => "edit any faq content"
202 => "edit any form content"
203 => "edit any front content"
204 => "edit any group content"
205 => "edit any landing_page content"
206 => "edit any member_update content"
207 => "edit any news content"
208 => "edit any page content"
209 => "edit any person content"
210 => "edit any policy_update content"
211 => "edit any promo content"
212 => "edit any publication content"
213 => "edit any resource content"
214 => "edit any resource_series content"
215 => "edit any simpleads content"
216 => "edit any slide content"
217 => "edit any system_page content"
218 => "edit any team content"
219 => "edit any vimeo_stream content"
220 => "edit any voting_form content"
221 => "edit any webform content"
222 => "edit own admin_help_page content"
223 => "edit own blog content"
224 => "edit own country content"
225 => "edit own elearning_module content"
226 => "edit own event content"
227 => "edit own external_course content"
228 => "edit own external_event content"
229 => "edit own external_jobs content"
230 => "edit own faq content"
231 => "edit own form content"
232 => "edit own front content"
233 => "edit own group content"
234 => "edit own landing_page content"
235 => "edit own member_update content"
236 => "edit own news content"
237 => "edit own page content"
238 => "edit own person content"
239 => "edit own policy_update content"
240 => "edit own promo content"
241 => "edit own publication content"
242 => "edit own resource content"
243 => "edit own resource_series content"
244 => "edit own simpleads content"
245 => "edit own slide content"
246 => "edit own system_page content"
247 => "edit own team content"
248 => "edit own vimeo_stream content"
249 => "edit own voting_form content"
250 => "edit own webform content"
251 => "edit users by role"
252 => "revert admin_help_page revisions"
253 => "revert all revisions"
254 => "revert blog revisions"
255 => "revert country revisions"
256 => "revert elearning_module revisions"
257 => "revert event revisions"
258 => "revert external_course revisions"
259 => "revert external_event revisions"
260 => "revert external_jobs revisions"
261 => "revert faq revisions"
262 => "revert form revisions"
263 => "revert front revisions"
264 => "revert group revisions"
265 => "revert landing_page revisions"
266 => "revert member_update revisions"
267 => "revert news revisions"
268 => "revert page revisions"
269 => "revert person revisions"
270 => "revert policy_update revisions"
271 => "revert promo revisions"
272 => "revert publication revisions"
273 => "revert resource revisions"
274 => "revert resource_series revisions"
275 => "revert simpleads revisions"
276 => "revert slide revisions"
277 => "revert system_page revisions"
278 => "revert team revisions"
279 => "revert vimeo_stream revisions"
280 => "revert voting_form revisions"
281 => "revert webform revisions"
282 => "select account cancellation method"
283 => "update paragraph content attachment"
284 => "update paragraph content attachments"
285 => "update paragraph content block"
286 => "update paragraph content call_to_action"
287 => "update paragraph content faqs"
288 => "update paragraph content faqs_accordion"
289 => "update paragraph content feed"
290 => "update paragraph content form"
291 => "update paragraph content from_library"
292 => "update paragraph content gallery"
293 => "update paragraph content hero_card"
294 => "update paragraph content home_featured_events"
295 => "update paragraph content home_featured_items"
296 => "update paragraph content home_latest"
297 => "update paragraph content iframe"
298 => "update paragraph content link_flexi"
299 => "update paragraph content links"
300 => "update paragraph content links_flexi_container"
301 => "update paragraph content map_world"
302 => "update paragraph content promo"
303 => "update paragraph content q_a"
304 => "update paragraph content quote"
305 => "update paragraph content slider"
306 => "update paragraph content social_links"
307 => "update paragraph content stream_day"
308 => "update paragraph content stream_session"
309 => "update paragraph content tagged"
310 => "update paragraph content team"
311 => "update paragraph content team_member"
312 => "update paragraph content twitter"
313 => "update paragraph content video"
314 => "update paragraph content view"
315 => "update paragraph content wysiwyg"
316 => "use admin toolbar search"
317 => "use editorial transition archive"
318 => "use editorial transition archived_draft"
319 => "use editorial transition archived_published"
320 => "use editorial transition create_new_draft"
321 => "use editorial transition publish"
322 => "use external_event_workflow transition create_new_draft"
323 => "use external_event_workflow transition publish"
324 => "view admin_help_page revisions"
325 => "view all revisions"
326 => "view any unpublished content"
327 => "view blog revisions"
328 => "view country revisions"
329 => "view elearning_module revisions"
330 => "view event revisions"
331 => "view external_course revisions"
332 => "view external_event revisions"
333 => "view external_jobs revisions"
334 => "view faq revisions"
335 => "view form revisions"
336 => "view front revisions"
337 => "view group revisions"
338 => "view landing_page revisions"
339 => "view latest version"
340 => "view member_update revisions"
341 => "view news revisions"
342 => "view own unpublished content"
343 => "view page revisions"
344 => "view paragraph content attachment"
345 => "view paragraph content attachments"
346 => "view paragraph content block"
347 => "view paragraph content call_to_action"
348 => "view paragraph content faqs"
349 => "view paragraph content faqs_accordion"
350 => "view paragraph content feed"
351 => "view paragraph content form"
352 => "view paragraph content from_library"
353 => "view paragraph content gallery"
354 => "view paragraph content hero_card"
355 => "view paragraph content home_featured_events"
356 => "view paragraph content home_featured_items"
357 => "view paragraph content home_latest"
358 => "view paragraph content iframe"
359 => "view paragraph content link_flexi"
360 => "view paragraph content links"
361 => "view paragraph content links_flexi_container"
362 => "view paragraph content map_world"
363 => "view paragraph content promo"
364 => "view paragraph content q_a"
365 => "view paragraph content quote"
366 => "view paragraph content slider"
367 => "view paragraph content social_links"
368 => "view paragraph content stream_day"
369 => "view paragraph content stream_session"
370 => "view paragraph content tagged"
371 => "view paragraph content team"
372 => "view paragraph content team_member"
373 => "view paragraph content twitter"
374 => "view paragraph content video"
375 => "view paragraph content view"
376 => "view paragraph content wysiwyg"
377 => "view person revisions"
378 => "view policy_update revisions"
379 => "view promo revisions"
380 => "view publication revisions"
…10
]
]
"bundle" => "user_role"
]
]
"default_langcode" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_default" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_translation_affected" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"metatag" => array:3 [
0 => array:2 [
"tag" => "meta"
"attributes" => array:2 [
"name" => "title"
"content" => "publishing | British Geriatrics Society"
]
]
1 => array:2 [
"tag" => "meta"
"attributes" => array:2 [
"name" => "description"
"content" => "British Geriatrics Society"
]
]
2 => array:2 [
"tag" => "link"
"attributes" => array:2 [
"rel" => "canonical"
"href" => "https://d10upgrade.bgs.org.uk/users/amy-brewerton"
]
]
]
"role_change" => array:1 [
0 => array:1 [
"target_id" => "__role_delegation_empty_field_value__"
]
]
"revision_created" => array:1 [
0 => array:1 [
"value" => "1729758232"
]
]
"revision_user" => array:1 [
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"entity" => array:46 [
"uid" => array:1 [ …1]
"uuid" => array:1 [ …1]
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"preferred_admin_langcode" => []
"name" => array:1 [ …1]
"pass" => array:1 [ …1]
"mail" => array:1 [ …1]
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"status" => array:1 [ …1]
"created" => array:1 [ …1]
"changed" => array:1 [ …1]
"access" => array:1 [ …1]
"login" => array:1 [ …1]
"init" => []
"roles" => array:10 [ …10]
"default_langcode" => array:1 [ …1]
"revision_default" => array:1 [ …1]
"revision_translation_affected" => array:1 [ …1]
"metatag" => array:3 [ …3]
"role_change" => array:1 [ …1]
"revision_created" => array:1 [ …1]
"revision_user" => array:1 [ …1]
"revision_log_message" => []
"path" => array:1 [ …1]
"civicrm_contact_place_of_work" => array:1 [ …1]
"civicrm_contact_region" => array:1 [ …1]
"civicrm_contact_biography" => array:1 [ …1]
"civicrm_contact_prefix" => array:1 [ …1]
"civicrm_contact_job_title" => array:1 [ …1]
"field_blog_subscribers" => array:1 [ …1]
"field_e_bulletin" => array:1 [ …1]
"field_events_e_bulletin_" => array:1 [ …1]
"field_legacy_id" => array:1 [ …1]
"field_member_alert" => []
"field_metatag" => []
"field_national_council_bulletin_" => array:1 [ …1]
"field_nurses_and_ahp_bulletin" => array:1 [ …1]
"field_privacy_statement" => array:1 [ …1]
"field_region_bulletin_" => array:1 [ …1]
"field_sig_and_section_bulletins_" => array:1 [ …1]
"field_special_interest_groups" => array:4 [ …4]
"field_sponsored_e_bulletin" => array:1 [ …1]
"field_trainees_bulletin_" => array:1 [ …1]
"user_picture" => []
]
"bundle" => "user"
]
]
"revision_log_message" => []
"path" => array:1 [
0 => array:3 [
"alias" => "/users/amy-brewerton"
"pid" => "83012"
"langcode" => "en"
]
]
"civicrm_contact_place_of_work" => array:1 [
0 => array:1 [
"#markup" => "British Geriatrics Society"
]
]
"civicrm_contact_region" => array:1 [
0 => array:1 [
"#markup" => "British Geriatrics Society"
]
]
"civicrm_contact_biography" => array:1 [
0 => array:1 [
"#markup" => "Amy"
]
]
"civicrm_contact_prefix" => array:1 [
0 => array:1 [
"#markup" => "1 Amy Brewerton"
]
]
"civicrm_contact_job_title" => array:1 [
0 => array:1 [
"#markup" => "Publications & Website Editor"
]
]
"field_blog_subscribers" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_e_bulletin" => array:1 [
0 => array:1 [
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]
]
"field_events_e_bulletin_" => array:1 [
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"value" => "0"
]
]
"field_legacy_id" => array:1 [
0 => array:1 [
"value" => "14122"
]
]
"field_member_alert" => []
"field_metatag" => []
"field_national_council_bulletin_" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_nurses_and_ahp_bulletin" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_privacy_statement" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"field_region_bulletin_" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_sig_and_section_bulletins_" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_special_interest_groups" => array:1 [
0 => array:3 [
"target_id" => "7243"
"entity" => array:22 [
"tid" => array:1 [ …1]
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"vid" => array:1 [ …1]
"revision_created" => array:1 [ …1]
"revision_user" => []
"revision_log_message" => []
"status" => array:1 [ …1]
"name" => array:1 [ …1]
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"metatag" => array:2 [ …2]
"path" => array:1 [ …1]
"publish_on" => []
"unpublish_on" => []
"field_civicrm_entity" => []
]
"bundle" => "group"
]
]
"field_sponsored_e_bulletin" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_trainees_bulletin_" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"user_picture" => []
]
"bundle" => "user"
]
]
"title" => array:1 [
0 => array:1 [
"value" => "Be proactive: Delivering proactive care - Chapter one: Introduction"
]
]
"created" => array:1 [
0 => array:1 [
"value" => "1731412676"
]
]
"changed" => array:1 [
0 => array:1 [
"value" => "1732183104"
]
]
"promote" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"sticky" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"default_langcode" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_default" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"revision_translation_affected" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"moderation_state" => []
"body_class" => []
"specific_node_class" => []
"promote_to_featured_on_home_page" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"metatag" => array:2 [
0 => array:2 [
"tag" => "meta"
"attributes" => array:2 [
"name" => "title"
"content" => "Be proactive: Delivering proactive care - Chapter one: Introduction | British Geriatrics Society"
]
]
1 => array:2 [
"tag" => "link"
"attributes" => array:2 [
"rel" => "canonical"
"href" => "https://d10upgrade.bgs.org.uk/resources/be-proactive-delivering-proactive-care-chapter-one-introduction"
]
]
]
"path" => array:1 [
0 => array:3 [
"alias" => "/resources/be-proactive-delivering-proactive-care-chapter-one-introduction"
"pid" => "132039"
"langcode" => "en"
]
]
"publish_on" => []
"unpublish_on" => []
"menu_link" => []
"bgs_view_sections_postscript" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "sections"
"#display_id" => "postscript"
"#embed" => true
]
]
"bgs_view_resource_feedback" => array:1 [
0 => array:3 [
"#type" => "details"
"#title" => Drupal\Core\StringTranslation\TranslatableMarkup {#4075
#string: "Feedback on this resource?"
#arguments: []
#translatedMarkup: null
#options: []
#stringTranslation: Drupal\Core\StringTranslation\TranslationManager {#380
#translators: array:1 [
30 => array:1 [
0 => Drupal\Core\StringTranslation\Translator\CustomStrings {#385
#translations: array:1 [ …1]
#settings: Drupal\Core\Site\Settings {#12 …1}
#_serviceIds: []
#_entityStorages: []
}
]
]
#sortedTranslators: array:1 [
0 => Drupal\Core\StringTranslation\Translator\CustomStrings {#385}
]
#defaultLangcode: "en"
}
}
"form" => array:2 [
"#type" => "webform"
"#webform" => "webform_227"
]
]
]
"bgs_view_resource_series_resource_related" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "resource_series"
"#display_id" => "related_auto_manual"
"#embed" => true
]
]
"bgs_view_sections_additional" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "sections"
"#display_id" => "additional"
"#embed" => true
]
]
"bgs_view_sections_hero" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "sections"
"#display_id" => "hero"
"#embed" => true
]
]
"bgs_view_resource_series_other_resources" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "resource_series"
"#display_id" => "other_resources"
"#embed" => true
]
]
"bgs_view_sections_main" => array:1 [
0 => array:4 [
"#type" => "view"
"#name" => "sections"
"#display_id" => "main"
"#embed" => true
]
]
"field_body" => []
"field_clinical_research_type" => []
"field_date" => array:1 [
0 => array:1 [
"value" => "2024-11-14"
]
]
"field_date_display_override" => []
"field_date_updated" => array:1 [
0 => array:1 [
"value" => "2024-11-14T11:34:00"
]
]
"field_feedback_form" => array:1 [
0 => array:1 [
"value" => "1"
]
]
"field_full_title" => array:1 [
0 => array:1 [
"value" => "Be proactive: Delivering proactive care - Chapter one: Introduction"
]
]
"field_group" => array:1 [
0 => array:3 [
"target_id" => "7243"
"message" => "Recursion detected."
"array_path" => "uid.0.entity.field_special_interest_groups.0.entity"
]
]
"field_hide_card_date" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_image" => []
"field_legacy_id" => array:1 [
0 => array:1 [
"value" => "7640"
]
]
"field_legacy_revision_id" => array:1 [
0 => array:1 [
"value" => "41675"
]
]
"field_legacy_url_alias" => array:1 [
0 => array:1 [
"value" => "/resources/be-proactive-delivering-proactive-care-chapter-one-introduction"
]
]
"field_main_content" => array:2 [
0 => array:4 [
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"target_revision_id" => "16891"
"entity" => array:25 [
"id" => array:1 [
0 => array:1 [
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]
]
"uuid" => array:1 [
0 => array:1 [
"value" => "X93lE68c-2f0d-4c05-a3a9-e65c705f2d8b"
]
]
"revision_id" => array:1 [
0 => array:1 [
"value" => "16891"
]
]
"langcode" => array:1 [
0 => array:1 [
"value" => "en"
]
]
"type" => array:1 [
0 => array:3 [
"target_id" => "wysiwyg"
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<h2 class="sidebar-nav">Background</h2>\r\n
\r\n
<p class="larger-text">In June 2023, the British Geriatrics Society (BGS) published <a href="/Blueprint"><em>Joining the dots: A blueprint for preventing and managing frailty in older people</em></a>.<sup>1</sup> The publication acts as a blueprint to illustrate what good-quality age-attuned integrated care for older people looks like and makes the case for investing in services that prevent and manage frailty in older people. The blueprint sets out seven touchpoints of care that should be available to older people and makes 12 system recommendations. One of these vital touchpoints is “population-based proactive anticipatory care” which highlights the importance of care that targets people at risk of poor health and social outcomes to offer tailored support to stay healthier for longer.</p>\r\n
\r\n
<p>This publication will explore the touchpoint in further depth, specifically focusing on proactive care aimed at older individuals with moderate or severe frailty receiving care in primary and community settings. This expands on NHS England’s <a href="https://www.england.nhs.uk/long-read/proactive-care-providing-care-and-support-for-people-living-at-home-with-moderate-or-severe-frailty/"><em>Proactive care: providing care and support to people living at home with moderate and severe frailty</em></a>,<sup>2</sup> which is one of the three workstreams of the Ageing Well programme as published in the <a href="https://www.england.nhs.uk/publication/the-nhs-long-term-plan/"><em>NHS Long Term Plan</em></a> in 2019.<sup>5</sup> Mapped onto NHS England’s five core components and three enablers of proactive care, this document acts as a roadmap on delivering proactive care for older people with frailty. It follows on from BGS’s <a href="https://www.bgs.org.uk/ProactiveCareEvidence"><em>Be proactive: Evidence supporting proactive care for older people with frailty</em></a>, which outlines the evidence base for proactive care.<sup>3</sup> It is hoped that those designing proactive care services will use all three documents in both making the business case for proactive care and delivering it. </p>\r\n
\r\n
<h2 class="sidebar-nav">How was this publication developed?</h2>\r\n
\r\n
<p>This publication was developed by members of the BGS’s <a href="https://www.bgs.org.uk/CPCgroup">Community and Primary Care Group (CPCG)</a>. It was informed by three workshops with a Professional Advisory Board consisting of 21 healthcare professionals from a range of healthcare backgrounds and locations, held between March – May 2024. The workshops focussed on the benefits of proactive care approaches, barriers and enablers to the implementation of proactive care services, approaches to the identification of people with frailty, and how proactive care can be implemented into the wider health policy system. </p>\r\n
\r\n
<h2 class="sidebar-nav">Proactive care policy</h2>\r\n
\r\n
<p>In December 2023, NHS England published guidance on proactive care, outlining how it can be used to provide care and support for people living at home with moderate or severe frailty.<sup>2</sup> The guidance builds on previous reports calling for a transition to proactive care for patients living with frailty in the community. This includes the Fuller Stocktake, which calls for a healthcare system that better anticipates and manages the needs of individuals with frailty through more integrated, proactive, and community-centred care.<sup>6</sup> Outlined methods include the identification of patients with frailty and targeted delivery of interventions to prevent crisis, integrated care to support improved transitions of care, place-based models of care, and investment in Multidisciplinary Teams (MDTs). Similarly, the <a href="https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2023-health-in-an-ageing-society"><em>England Chief Medical Officer’s annual report 2023: health in an ageing society</em> </a>highlights the importance of maximising the independence of older people through the promotion of healthy ageing.<sup>7</sup> This will prevent and delay the onset of frailty in older people and in turn reduce hospital admissions, which has increased over the last 15 years.<sup>8</sup> This requires investment and a re-focus on care delivered within community and public health settings.</p>\r\n
\r\n
<p>Whilst England is the only nation in the UK with a national proactive care framework, health and social care policy in Scotland, Wales, and Northern Ireland also features proactive care. In Scotland, the 2017 <em><a href="https://www.gov.scot/publications/health-social-care-standards-support-life/">Health and Social Care Standards: My Support, My Life </a></em>emphasised the importance of early identification and support for individuals with frailty.<sup>9</sup> In 2024, the <a href="https://www.healthcareimprovementscotland.scot/publications/ageing-and-frailty-standards/"><em>Ageing and Frailty draft standards</em> </a>for the care of older people were published with 11 standards, which included the proactive identification of people living with frailty.<sup>10</sup> In Wales, the <em><a href="https://www.gov.wales/older-people-and-people-living-frailty-integrated-quality-statement-html">Older people and people living with frailty: integrated quality statement</a></em> published in January 2024 called for integrated community focused care to provide proactive, urgent and crisis care management in the community. <sup>11</sup> This will involve proactive identification and management of frailty as a long-term condition to prevent, delay, reverse or slow down its progression. Finally, in Northern Ireland one of the four core priorities of the Northern Ireland frailty network is the early identification of frailty to deliver more efficacious management of frailty.<sup>12</sup></p>\r\n
\r\n
<p>The NHS England proactive care guidance is a crucial starting point for Integrated care Boards (ICBs) and provider organisations designing and implementing proactive care.<sup>2</sup> The guidance identifies five core components of the proactive care approach and three enablers: </p>\r\n
\r\n
<h2 class="sidebar-nav">Core components </h2>\r\n
\r\n
<ol style="margin-left: 40px;">\r\n
\t<li><strong>Identifying the target cohort for whom there is the greatest potential impact on health and system outcomes. </strong></li>\r\n
\t<li><strong>Carrying out holistic assessments, such as a Comprehensive Geriatric Assessment</strong></li>\r\n
\t<li><strong>Developing a personalised care and support plan. </strong></li>\r\n
\t<li><strong>Delivering Co-ordinated multi-professional interventions to address the person’s range of needs. </strong></li>\r\n
\t<li><strong>Providing a clear plan for continuity of care, including an agreed schedule of follow-ups. </strong></li>\r\n
</ol>\r\n
\r\n
<h2 class="sidebar-nav">Key enablers </h2>\r\n
\r\n
<ol style="margin-left: 40px;">\r\n
\t<li><strong>Flexible workforce.</strong></li>\r\n
\t<li><strong>Shared care record.</strong></li>\r\n
\t<li><strong>Clear accountability and shared decision-making.</strong></li>\r\n
</ol>\r\n
\r\n
<p>The NHS England guidance identifies the importance of proactive care but lacks specific details about how to implement proactive care services in local areas and at larger scales. Whilst it is a key starting point, the BGS is disappointed in the absence of funding for the programme compared to what was originally proposed.<sup>13</sup> This document aims to build on the NHS England guidance through outlining how to deliver the five core components and three key enablers of proactive care. </p>\r\n
\r\n
<h2 class="sidebar-nav">Audience</h2>\r\n
\r\n
<p>Supporting primary and community care services to deliver proactive care programmes is in the interest of the wider health system. However, given the broad range of challenges, coordinated action is required incorporating the whole multidisciplinary team. This document aims to be a useful guide for healthcare professionals, clinical leaders, commissioners, and system designers wishing to set up proactive care services within primary and community care settings in their local areas. It also provides commissioners and policy makers with key recommendations on how to set these services up on a larger scale. Whilst we use the NHS England guidance as a starting point, the principles outlined in this document can be implemented across all four nations. </p>\r\n
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<h2 class="sidebar-nav">What is proactive care? </h2>\r\n
\r\n
<h5>Defining proactive care</h5>\r\n
\r\n
<p>Frailty is not an inevitable part of ageing, and proactive care aims to reduce or delay negative health outcomes through targeting those at risk of frailty and tailoring health interventions to support them live well for longer. It aims to delay the onset of health deterioration, maintain independent living, and reduce avoidable periods of ill health, thereby reducing unplanned care.<sup>2</sup> Most healthcare interactions for older people with frailty take place in primary care, and it is therefore a crucial setting for proactive care services to be implemented. <sup>14</sup> Within primary and community care, there is an increasing focus upon proactive models of care to identify, assess and manage older people with frailty to mitigate the negative impacts of frailty on individuals and healthcare systems.<sup>15 </sup>Importantly, this transforms care from being reactive, fragmented, and episodic to personalised, community-based, and coordinated.<sup>16</sup></p>\r\n
\r\n
<h5>Benefits of proactive care</h5>\r\n
\r\n
<p>There is significant scope for proactive care delivery within primary and community care systems to improve patient-centred outcomes and system-centred outcomes. Benefits to patients include improved quality of life, reduction in loneliness/isolation, reduction in carer burden, and the maintenance of independence.<sup>17</sup> In turn, this can lead to wider healthcare system benefits, such as reduced hospital admissions and re-admissions. </p>\r\n
\r\n
<h5>Target cohort for proactive care</h5>\r\n
\r\n
<p>The NHS England guidance on proactive care focuses on people with moderate to severe frailty living in their own homes, excluding those with mild frailty. Most healthcare professionals working with older people will be caring for those with moderate to severe frailty, and therefore, our focus will also be on this cohort. The BGS recognises the importance of targeting those with mild frailty and the biggest system impact may be had by targeting this cohort. However, due to the high number of older people with mild frailty, this will require a different preventative screening approach, focussing largely on public health interventions incorporating exercise, nutrition, and overall wellbeing.<sup>18</sup></p>\r\n
\r\n
<h2 class="sidebar-nav">The evidence base</h2>\r\n
\r\n
<p>There are conflicting concepts around frailty, its measurement and its relationship to multiple long-term conditions, ageing and disability.<sup>19</sup> Despite this, there is a broad consensus that the impact of frailty on individuals and care systems warrant a proactive inter-professional primary care approach to identification, assessment and management.<sup>20</sup></p>\r\n
\r\n
<p>There is evidence that proactive care programmes for patients with frailty are beneficial, with trials in the UK and Netherlands reporting reduced functional decline, improved quality of care, improved wellbeing, and improved quality of life.<sup>21-23</sup> Individualised care planning, including medicines optimisation and regular review, has been identified as the intervention with the strongest evidence base for sustaining independence in older people in the community.<sup>24</sup> Similarly, continuity of care has been identified as vital in proactive care service’s success and delivery. </p>\r\n
\r\n
<p>Currently, the implementation of proactive care programmes is based on evidence-informed rather than evidence-based practice, which can prove challenging for commissioners. However, clinical research and quality improvement will lead to adjustments and redesign of proactive frailty interventions and help support the development of new knowledge and evidence for this patient group.<sup>25</sup></p>\r\n
\r\n
<p>The ability for different localities to implement proactive care programmes for patients with frailty is dependent on funding and workforce pressures. Despite this, current evidence highlights four key themes for the successful delivery of proactive care services. Firstly, the ability for a service to deliver Comprehensive Geriatric Assessment (CGA) is a priority. CGAs should provide patient centred assessments to identify symptoms or functional decline, including screening tools such as the PRISMA-7 questionnaire, Gait-Speed (four-metre walk), and timed-up-and-go tests.<sup>26</sup> Secondly, the identification of a clearly defined group of patients is pertinent. Depending on the size of the proactive care programme, this can range from annual screenings with frailty tools, to the identification of individuals with a high number of primary care contacts, home visits, medications, or medical conditions.<sup>27</sup> The type of intervention needs to be tailored depending on size, resources, and aims. Thirdly, it is important that proactive care programmes are resourced sufficiently.<sup>28,29 </sup>While there appears to be general support for proactive care programmes from GPs, there are concerns that under resourced interventions will lead to high workloads without benefits.<sup>28,29</sup> Finally, integration with the broader health and social care system is beneficial to support wider components of care, such as nutrition, social interaction, and exercise. Examples include linking to social prescribers, referrals to day centres or community hubs, and integration with the third sector. </p>\r\n
\r\n
<p><span style="font-size:10.0pt"><span style="font-family:"Verdana",sans-serif">BGS's <em><a href="https://www.bgs.org.uk/ProactiveCareEvidence">Be proactive: Evidence supporting proactive care for older people with frailty</a></em><sup>3 </sup>provides further information on the evidence base behind proactive care. This document outlines detailed evidence which was originally gathered to inform the NHS England guidance document and has been published with the approval of NHS England. Healthcare teams will be able to use this evidence to build business cases for proactive care services.</span></span></p>\r\n
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<p class="larger-text">These BGS publications outline evidence and delivery recommendations for proactive care and support for older adults with moderate to severe frailty. </p>\r\n
\r\n
<p>We set out how to deliver proactive care against core components and key enablers, with recommendations for success of a proactive care service. Building on NHS England's proactive care guidance, <strong><a href="https://www.england.nhs.uk/long-read/proactive-care-providing-care-and-support-for-people-living-at-home-with-moderate-or-severe-frailty"><em>Proactive care: providing care and support for people living at home with moderate or severe frailty</em></a></strong>, we also outline key recommendations for the successful implementation of proactive care services across the UK. </p>\r\n
\r\n
<p>We hope that users will be able to use all three documents when designing proactive care services, with the NHS England guidance document acting as key framework and starting point, BGS’s <a href="/ProactiveCareEvidence"><strong><em>Be proactive: Evidence supporting proactive care for older people with frailty</em></strong></a> as a business case, and <a href="/resources/be-proactive-delivering-proactive-care-overview"><em><strong>Be proactive: Delivering proactive care for older people with frailty </strong></em></a>as a roadmap for implementing the NHS England framework and delivering services.</p>\r\n
\r\n
<p>As part of this work, the BGS has collected a list of case studies from our members across the UK, illustrating existing examples of proactive care services in community and primary settings. These can be viewed <a href="/proactivecasestudies">here</a>.</p>\r\n
\r\n
<p>Please use the links below to navigate the reports, or click to download the full reports in PDF version:</p>\r\n
\r\n
<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">\r\n
\t<tbody>\r\n
\t\t<tr>\r\n
\t\t\t<td>Download <strong><em><a href="https://www.bgs.org.uk/sites/default/files/content/attachment/2024-10-29/Be%20proactive%20-%20Evidence%20supporting%20proactive%20care%20for%20older%20people%20with%20frailty.pdf">Be proactive: Evidence supporting proactive care for older people with frailty</a></em> </strong>in PDF format.</td>\r\n
\t\t</tr>\r\n
\t\t<tr>\r\n
\t\t\t<td>Download <strong><a href="https://www.bgs.org.uk/sites/default/files/content/attachment/2024-11-13/Be%20proactive%20-%20Delivering%20proactive%20care%20for%20older%20people%20with%20frailty.pdf"><em>Be proactive: Delivering proactive care for older people with frailty</em> </a></strong>in<strong> </strong>PDF format.</td>\r\n
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