Since 2022, the new Armed Forces ‘Covenant Legal Duty’ has required public bodies to have ‘due regard’ for veterans, those still working in the armed forces and their families. For the first time, this legal duty has been included in the GMS Contract, meaning GPs must consider the unique circumstances of veterans. This includes being mindful that veterans will have spent time away from family and likely seen or been affected by incidents not typically experienced by civilians.
In most cases, when someone leaves the forces, they won’t have had much involvement with their local GP practice. It’s common for veterans to be reluctant to ask for help and they may put off booking a doctor’s appointment for fear of being asked questions they don’t feel able or willing to discuss.
There are 2.4 million veterans living in the UK and according to a survey from NHS England, around 60% have found it difficult to ask for help if they are struggling with their mental health.
The Veteran Friendly GP Practice Accreditation Scheme is designed to help veterans and their families get access to specialist care pathways that are appropriate for their needs and equip GP practices with the relevant skills to support them. Commissioned by NHS England and accredited by the Royal College of General Practitioners (RCGP), the scheme recognises the unique way in which military service of any kind can impact physical and mental health. For GPs, the accreditation scheme not only demonstrates a commitment to supporting veterans and their families, but also equips them with the skills and competencies to provide high quality care with limited impact on time and resources.
In 2022, however, just 28% of practices in England had become accredited. NHS Arden & GEM CSU was tasked with increasing take-up of the scheme, with an initial target of accrediting 40% of practices.
Enabling fast access to the right care
The principal aim of the accreditation scheme is to remove variation in and barriers to healthcare for veterans and their families, and ensure they receive appropriate treatment. There are specific national pathways available to veterans which are designed to cater for the needs of military personnel. These pathways provide faster access to care which is provided by experts with a detailed understanding of the needs of veterans and their families.
- Operation Restore (Op Restore): a care pathway for physical injuries which is run centrally in England by an NHS surgeon who is a member of the army reserves. The small team of clinicians who triage referrals understand the language and likely impact of different injuries based on experience, without having to make patients relive their stories in detail which can be triggering.
- Operation Courage (Op Courage): a mental health care pathway available both to veterans and family members thorough self-referral or GP referral. As with OpRestore, the team is made up of people who understand the language and common life experiences of those who have served and their family members.
- Operation Nova (Op Nova): support for veterans in contact with the justice system, including help with wider determinants of health such as employment and housing.
- Operation Community (Op Community): currently running as a proof of concept in a number of locations across England with the primary intention of joining community resources and services together to enable better solutions for veterans and their families.
In addition to these formal pathways, a huge number of charities and voluntary organisations exist to support veterans and families that are often better placed to provide emotional or practical support for veterans than GPs. The veteran friendly scheme helps put practices in touch with these local networks, enabling additional resource and more effective social prescribing to support a broader range of needs.
It is not just the veterans and their families who benefit from these pathways and networks. By taking advantage of specific referral routes, there is more availability released for other patients, while GPs can spend less time supporting complex needs for veterans, knowing their patients are in safe hands.
The accreditation process
The veteran friendly scheme is free for practices, and it takes just 20 minutes to complete the initial registration. When applying, practices are asked approximately 30 questions which form the basis of their commitment to support veterans and includes:
- Providing named details of the practice’s clinical lead and admin lead,
- Signing up to understanding the difference between civilians and veterans and committing to increasing their awareness of the needs of veterans,
- Confirmation of a good or outstanding CQC rating, although those working on an improvement plan may be considered on a case by case basis.
Once registered, the practice can unlock a suite of resources and training courses to improve their understanding of how to best help veterans and their families, including the specialist referral routes available and supporting local and national voluntary groups. Training typically takes between three to four hours to complete.
Engaging practices and PCNs
Practices are under extreme pressure, making it understandably difficult to make time to understand, let alone apply for the Veteran Friendly Accreditation Scheme. Arden & GEM approached this from two angles – reaching out to practices and PCNs directly, while also tapping into armed forces networks to build demand from veterans. To do this required having the right skills in the team to communicate effectively with all parties. The entire Arden & GEM project team (seven people) is made up of veterans, of which four have a clinical background and three currently work in primary care. This means our team speaks the language of both the veterans we’re trying to support and the clinicians we want to interest in the scheme.
Targeted promotional activity to date has included a facilitated Q&A for primary care providers, with supporting video and podcast to explain the benefits of the scheme, as well as broader media relations, face to face and virtual meetings, and widespread social media engagement.
Building relationships with military groups and charities that support veterans has proved crucial in encouraging veterans to seek health support and ask their GP about the scheme.
Outcomes
We saw a substantial increase in take-up shortly after taking on the campaign, reaching our initial target of 40% accredited practices well ahead of time. As at mid-July 2024, 58% of practices were accredited, a total of 3625. We are aiming to have at least one accredited practice in every PCN in England by autumn 2024 (currently standing at 97%).
Feedback from veterans has been extremely positive, and anecdotal evidence has shown that with both veterans and GP practices understanding the care pathways available to them, it is becoming easier for veterans and their families to ask for help.
A patient from the Midlands who had a hip replacement through Op Restore has now returned to normal life, speaks freely of better mental health thanks to support via Op Courage, and attributes his progress to his accredited GP practice knowing what to do when he first approached them for help.
Queen’s Nurse, Helen Hurst, who supports veterans registered at her practice said: ‘I’m proud of the NHS for stepping up. We’ve got that whole duty of care towards our armed forces and we want to make that difference as well to their community.’
Dr Robin Simpson from Hampton Surgery also acknowledged the wider benefits for primary care. ‘This programme will help take away work from GPs, as once they recognise that someone has [for example] a mental health problem, there’s a really good referral pathway that’s going to help them.’
Through this scheme, practices are better equipped to access the right care and support for their veteran population and meet their legal duty to have ‘due regard’ for those who have and are working in the armed forces and their families.
