array:67 [
"nid" => array:1 [
0 => array:1 [
"value" => "55448"
]
]
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0 => array:1 [
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]
]
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]
]
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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 [
"value" => "0"
]
]
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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"
381 => "view resource revisions"
382 => "view resource_series revisions"
383 => "view simpleads revisions"
384 => "view slide revisions"
385 => "view system_page revisions"
386 => "view team revisions"
387 => "view user email addresses"
388 => "view vimeo_stream revisions"
389 => "view voting_form revisions"
390 => "view webform revisions"
]
]
"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 [
0 => array:3 [
"target_id" => "595"
"entity" => array:46 [
"uid" => array:1 [
0 => array:1 [ …1]
]
"uuid" => array:1 [
0 => array:1 [ …1]
]
"revision_id" => array:1 [
0 => array:1 [ …1]
]
"langcode" => array:1 [
0 => array:1 [ …1]
]
"preferred_langcode" => array:1 [
0 => array:1 [ …1]
]
"preferred_admin_langcode" => []
"name" => array:1 [
0 => array:1 [ …1]
]
"pass" => array:1 [
0 => array:1 [ …1]
]
"mail" => array:1 [
0 => array:1 [ …1]
]
"timezone" => array:1 [
0 => array:1 [ …1]
]
"status" => array:1 [
0 => array:1 [ …1]
]
"created" => array:1 [
0 => array:1 [ …1]
]
"changed" => array:1 [
0 => array:1 [ …1]
]
"access" => array:1 [
0 => array:1 [ …1]
]
"login" => array:1 [
0 => array:1 [ …1]
]
"init" => []
"roles" => array:10 [
0 => array:3 [ …3]
1 => array:3 [ …3]
2 => array:3 [ …3]
3 => array:3 [ …3]
4 => array:3 [ …3]
5 => array:3 [ …3]
6 => array:3 [ …3]
7 => array:3 [ …3]
8 => array:3 [ …3]
9 => array:3 [ …3]
]
"default_langcode" => array:1 [
0 => array:1 [ …1]
]
"revision_default" => array:1 [
0 => array:1 [ …1]
]
"revision_translation_affected" => array:1 [
0 => array:1 [ …1]
]
"metatag" => array:3 [
0 => array:2 [ …2]
1 => array:2 [ …2]
2 => array:2 [ …2]
]
"role_change" => array:1 [
0 => array:1 [ …1]
]
"revision_created" => array:1 [
0 => array:1 [ …1]
]
"revision_user" => array:1 [
0 => array:3 [ …3]
]
"revision_log_message" => []
"path" => array:1 [
0 => array:3 [ …3]
]
"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 [
"value" => "0"
]
]
"field_events_e_bulletin_" => array:1 [
0 => array:1 [
"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]
"uuid" => array:1 [ …1]
"revision_id" => array:1 [ …1]
"langcode" => array:1 [ …1]
"vid" => array:1 [ …1]
"revision_created" => array:1 [ …1]
"revision_user" => []
"revision_log_message" => []
"status" => array:1 [ …1]
"name" => array:1 [ …1]
"description" => array:1 [ …1]
"weight" => array:1 [ …1]
"parent" => array:1 [ …1]
"changed" => array:1 [ …1]
"default_langcode" => array:1 [ …1]
"revision_default" => array:1 [ …1]
"revision_translation_affected" => array:1 [ …1]
"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 three: Recommendations "
]
]
"created" => array:1 [
0 => array:1 [
"value" => "1731428096"
]
]
"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 three: Recommendations | 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-three-recommendations"
]
]
]
"path" => array:1 [
0 => array:3 [
"alias" => "/resources/be-proactive-delivering-proactive-care-chapter-three-recommendations"
"pid" => "132041"
"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 {#4066
#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" => "2024-11-14T16:08:00"
]
]
"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 three: Recommendations "
]
]
"field_group" => []
"field_hide_card_date" => array:1 [
0 => array:1 [
"value" => "0"
]
]
"field_image" => []
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<p class="larger-text">In this chapter, the BGS sets out eight key recommendations which are crucial to the success of proactive care services across community and primary care settings in the UK. These recommendations require action from a range of commissioners, policymakers, providers and healthcare professionals at national, regional, and local levels and should be the building blocks for all involved in proactive care to aim and advocate for. </p>\r\n
\r\n
<p>There are a wide range of approaches to the delivery of proactive frailty care, tailored to location, population size, funding opportunities, workforce, deprivation and the infrastructure available. Examples include MDTs employed by community and acute trusts, PCN level services led by a single ACP, to practice level services using protected time for existing staff. In some locations, services are predominantly led by community teams incorporating primary care whilst others are solely led by primary care teams. Despite differences, the delivery of proactive care will require working across teams and settings to reduce duplication, facilitate shared learning, and improve the quality of referrals. Whilst it is important that proactive care teams must develop according to their local population, the following key recommendations should be applied across all services. </p>\r\n
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<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><strong>1. Proactive care services should be aligned to the approximate geography of a Primary Care Network (PCN)/Primary Care Cluster (PCC) or equivalent, with a dedicated proactive care team in each equivalent area across the UK</strong></td>\r\n
\t\t</tr>\r\n
\t</tbody>\r\n
</table>\r\n
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<p>In England, GP practices have joined together to form PCNs based around populations of 30,000 – 50,000 patients. Integrated Neighbourhood Teams (INTs) are starting to develop around PCNs, with the aim of shared ownership for improving the health and wellbeing of the PCN population. Teams from across PCNs, wider community services providers, secondary care teams, social care teams, and voluntary care organisations will work together to share resources and information, and form MDTs dedicated to improving the health and wellbeing of a local community and tackling health inequalities.<sup>6</sup></p>\r\n
\r\n
<p>In Scotland, GP Clusters are typically groups of between five to eight GP practices in a close geographical location. Their purpose is to encourage GPs to participate in quality improvement practices, and to contribute to the oversight and development of local practices.<sup>33</sup> Health and Social Care Partnerships, (HSCPs) deliver integrated services provided by Health Boards and Councils in Scotland, of which proactive frailty care would be one such service. Each partnership is jointly run by the NHS and local authority, with a total of 31 HSCPs across Scotland based upon geographical and population factors.<sup>34</sup></p>\r\n
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<p>In Wales, there are 64 Primary Care Clusters (PCCs), which bring together all local services involved in health and care across a geographical area, typically serving a population between 25,000 and 100,000. These PCCs are instrumental in commissioning community-based services.<sup>35</sup></p>\r\n
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<p>In Northern Ireland, there are 17 GP Federations with the aim to support practices and to deliver the transformation agenda. They work across a wide number of local health and social care agencies to implement innovative strategies to benefit the local population.36 The federations align geographically with Integrated Care Partnerships (ICPs) that serve approximately 25–30 practices covering 100,000 population. ICPs are groups of health and social care providers that work together to improve the health and wellbeing of their population focussing on improving services for people with long term conditions and older people with frailty.<sup>37</sup></p>\r\n
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<p>The size of a proactive care service should align approximately with the local infrastructure as described in the four nations. A vital component of this infrastructure should be the utilisation of the MDT to provide proactive, personalised care to older people with complex needs, as highlighted in the Fuller Stocktake.<sup>6</sup> This requires a shift from a psychosocial model of care to a more holistic population-based approach that supports the health and wellbeing of the whole community. Teams need to be co-located around the needs of the local population, with a mix of primary and secondary care expertise to wrap around older individuals at risk of frailty, as outlined in the BGS Blueprint.<sup>1</sup></p>\r\n
\r\n
<p>Targeting proactive care services at older people with frailty will likely be a priority for many PCNs/PCCs or equivalents, especially as the UK’s population continues to age. This is particularly important for rural and coastal areas where the growth in the older population is expected to accelerate at a faster rate.<sup>7</sup> The majority of healthcare that older people receive is in primary and community settings and many of the teams in community services, local authority services and voluntary organisations work with older people more than any other group. Therefore, services will already have the building blocks for an MDT to provide proactive care for older people. A dedicated core proactive care team for each PCN/ PCC or equivalent will create strong links between general practice, and the wider MDT, ensuring that the proactive care service is implemented and integrated across the PCN/cluster.</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><strong>2. Policy makers and commissioners should prioritise national funding and contractual arrangements to ensure that proactive care is available to all older people living with frailty in the community</strong></td>\r\n
\t\t</tr>\r\n
\t</tbody>\r\n
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<p>Across all four nations, there is a lack of funding for proactive care services with reactive services, such as Urgent Community Response, Hospital at Home and Same Day Emergency Care being prioritised. Currently, there is no national policy on preventing and reversing frailty, and therefore, proactive care services vary greatly across the UK. This has resulted in huge variations in funding opportunities, with some areas receiving funding through ICBs, PCNs, and Additional Roles Reimbursement Scheme (ARRS) funding whilst others using their core budget to fund protected time for existing staff to deliver proactive care services. In areas where no dedicated funding is available, it is often impossible to set up proactive care services. Recurrent national funding and guidance is vital to ensure that consistent and reliable proactive care services are available to all older people who need it. </p>\r\n
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<p>Proactive care is reliant on cross-organisational working. Contractual requirements on all stakeholders across acute, community, primary, and social care settings to prioritise proactive care in the community would help ensure organisations are incentivised to work together to deliver proactive care and remove referral barriers. </p>\r\n
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<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">\r\n
\t<tbody>\r\n
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\t\t\t\t<p><strong>3. Leadership is vital to the delivery of successful proactive care services, and it should be supported and nurtured through training opportunities and protected funding. </strong></p>\r\n
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<p>Setting up proactive care services requires strong compassionate clinical leadership. BGS members inform us that proactive care services are often set up due to the enthusiasm of individual healthcare professionals and clinical leaders. For example, individual healthcare professionals who have persuaded ICBs and Health Boards that proactive care is worth investing in; Community Geriatricians who have worked with colleagues to create a proactive care service using existing resources; and PCN Clinical Directors and practice GPs who have encouraged colleagues to commit time and resources into setting up proactive care services. This often involves clinical leaders taking on additional unpaid work to set up and develop the service. Small services may depend on one individual to establish the service, create the processes, and develop the links across the system. This is a leadership challenge, requiring individuals with significant leadership skills and commitment. Clinical leaders should be identified, supported, and nurtured with protected funded time to carry out their leadership role. Training and development opportunities are also vital, such as structured leadership training through national or regional bodies and informal mentoring with other clinical leaders. </p>\r\n
\r\n
<p>Alongside leadership, an effective operation manager who understands the aims of proactive care is needed to support and steer service improvements. They also have a role in supporting team members to change and in negotiating new ways of working with external teams and organisations. Key qualities of operational managers include experience with service development and negotiating skills. </p>\r\n
\r\n
<p>Working in proactive care can be challenging, requiring flexibility and resilience. Clinical leaders and operational managers have a role to play in easing challenges through setting a good workforce culture, keeping morale up, and providing training opportunities.</p>\r\n
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<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">\r\n
\t<tbody>\r\n
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\t\t\t<td><strong>4. Outcomes measures are vital in evaluating the success of proactive care interventions and should always be implemented when new services are launched. National guidance on how to measure the impact of proactive care interventions should be published, and investment is needed in clinical research and IT infrastructure focussed on data collection and evaluation. </strong></td>\r\n
\t\t</tr>\r\n
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\r\n
<p>It is vital that proactive care services measure the value of the service to ensure that the service meets the needs of the population and improvements are made. Decisions on how to measure outcomes should be made before the service is rolled out. It is difficult to measure the impact of proactive care, with commonly used measures, such as hospital admissions and early hospital discharge, less effective as this is not the primary outcome of proactive care. The primary aim is to maintain independence in older individuals, which is difficult to measure in the short term and often requires long-term data over three to five years. Additionally, suitable data, such as use of paid carers and care home admissions are not routinely collected. Options include patient reported outcomes, patient experience measures, and process measures. National guidance on how to measure the impact of proactive care would be beneficial, alongside clinical research evaluating the clinical utility of different approaches. </p>\r\n
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<p>Data collected should be reflective of the complex nature of CGA styled interventions and should involve patient centred outcomes and patient voices. Data collection and analysis is time consuming and should be supported by the broader health ecosystems to provide evidence of systems working in localities. Demonstration of effectiveness in a robust manner is difficult for complex interventions, but important for commissioners and funders. </p>\r\n
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<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><strong>5. Proactive care services should be staffed by a core multidisciplinary team, consisting of at least one GP with an interest in frailty, one ACP, and one Care Co-ordinator. A gold standard team would include professionals from social care, mental health services, therapies, pharmacy and geriatric medicine. </strong></td>\r\n
\t\t</tr>\r\n
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\r\n
<p>Proactive care in community and primary care settings requires a core team who work together to deliver what the patient needs rather than working to tightly defined pathways. At a minimum, the core team should include a GP with an interest in frailty, an ACP, and a Care Co-ordinator. A gold standard core team would also include professionals from social care, mental health, therapies, pharmacy, and geriatric medicine. <br />\r\n
\t <br />\r\n
\tHighly trained professionals, such as nurses, AHPs, therapists, and paramedics, are essential when managing complex caseloads but are in limited supply. Training and development of senior healthcare professionals to case manage complex cases should be a priority for the NHS workforce plan.<br />\r\n
\t <br />\r\n
\tMany GPs are interested in working in proactive care for people living with frailty, but funding is often not available to enable this. In England until recently, GPs have been excluded from the ARRS funding used to employ staff across PCNs in England. A recent welcome change to this policy means GPs can now be employed under ARRS across PCNs, but only if they are less than two years post GP qualification. Currently still excluded are the significant numbers of experienced GPs (many active members of the BGS) who have been developing skills and interest in frailty. This is potentially a waste of an existing workforce resource. If the ARRS policy was extended to allow employment of any GP to proactive frailty roles across PCNs the impacts of this welcome change could be much greater for preventative frailty work.<br />\r\n
\t <br />\r\n
\tCommunity Geriatricians would be valuable resource for proactive care services, however, there are currently not enough to meet the needs of the ageing population.<sup>38</sup> There is significant variation across the UK in the number of geriatricians available to care for older people. The BGS is calling for a UK-wide target of one consultant geriatrician per 500 people aged 85 and over. This would help to ensure that community geriatricians could play a key part in proactive care for older people across the UK. <br />\r\n
\t <br />\r\n
\tWhen working well, proactive care services have the potential to aid recruitment and retention as it allows staff to manage patients better which increases job satisfaction. </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><strong>6. Local and national investment in training and development opportunities for the multidisciplinary team working in proactive care is needed, including mandatory frailty training, training in communication, leadership, and coaching, and education on the wider health and care system. </strong></td>\r\n
\t\t</tr>\r\n
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<p>Proactive care team members need not only knowledge and understanding of frailty and complex care but the confidence, emotional intelligence and flexibility to build relationships with people within their teams and in other organisations and to work across organisational boundaries. National bodies and professional organisations should ensure that fully funded training and development opportunities are available for people working in proactive care. This should cover not only knowledge of frailty and frailty syndromes but understanding of the wider health and care system, advanced communication skills, and training in leadership and coaching skills.</p>\r\n
\r\n
<p>It can be quite challenging to change longstanding ways of working and work in an integrated team with people from very different backgrounds. Team building opportunities and joint training should be provided for newly created multidisciplinary teams to help them develop as a team. Networking events across regions are a good way to share new ideas and provide mutual support. </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><strong>7. A culture of flexible and cross organisational working should be embedded in proactive care services, which requires good working relationships across services. A shared proactive care workforce plan across the partner organisations in each PCN/PCC or equivalent should be developed. </strong></td>\r\n
\t\t</tr>\r\n
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\r\n
<p>Successful proactive care services rely on a united team that has a shared vision of person-centred care and permission to work outside of organisational boundaries. This is facilitated by trust and good working relationships within the MDT. At the heart of proactive care services is empowering people, both patients and staff, to deliver what is right for the patient. Healthcare professionals need to be equipped with the skills, agency, and flexibility, to work as a team to support each other in a new way of working. It is vital that time is spent while developing the service for the team to make links with external agencies to develop relationships and build trust. This will create a wider MDT who work together to avoid duplication, improve quality of referrals and ensure smooth coordination of care. </p>\r\n
\r\n
<p>It can take a long time to develop the skills and confidence to work in a different way. It requires a strong team, good clinical leadership, a supportive team manager and a consistent service. It is important to set realistic expectations during the early stages of the service to allow the team to develop into their roles. </p>\r\n
\r\n
<p>To ensure the proactive care team is supported with the appropriate staff resource, training opportunities, and ways of working, new services should create a shared workforce plan between partner organisations outlining how the service will work. </p>\r\n
\r\n
<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">\r\n
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\t\t\t<td><strong>8. Services across the UK should use BGS’s Be proactive: Evidence supporting proactive care for older people with frailty to make the case for proactive care services in their local area, and use Be proactive: Delivering proactive care for older people with frailty as a roadmap for implementing services. </strong></td>\r\n
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\r\n
<p>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 for People Living at Home with Moderate or Severe Frailty</em></a> emphasises the need for systematic identification and assessment of individuals with frailty, enabling early intervention tailored to their specific needs.<sup>2</sup> It outlines five core components and three key enablers as a framework for delivering proactive care. BGS’s <em>Be Proactive: Delivering Proactive Care for Older People with Frailty </em>expands on this framework, providing a roadmap for the delivery of proactive care. It acts as a guide for services in personalising care plans, fostering effective communication and coordination among multidisciplinary teams, and empowering patients to take an active role in managing their health. By focusing on continuous monitoring and adapting care plans to reflect changes in patients’ conditions, organisations can not only improve health outcomes but also promote a more sustainable healthcare model that anticipates and responds to the evolving needs of older individuals living with frailty. It complements BGS’s <a href="/ProactiveCareEvidence"><em>Be proactive: Evidence supporting proactive care for older people with frailty</em></a>, which outlines the evidence base supporting proactive care.<sup>3</sup> Healthcare professionals and clinical leaders will be able to use the evidence document as a business case for delivering proactive care and use the delivery document as a roadmap for implementing services. Together, the evidence and delivery documents create a robust framework for delivering effective, person-centred care in the community.</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
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<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
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\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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