GP services for older people: a guide for care home managers

Residents' entitlements and requirements - Protection of residents' rights

Managers should make sure that residents have their human, civil and statutory rights and entitlements protected in relation to their ongoing health care needs. They should have fair access to scarce resources and services, active involvement in their care plans and protection from discrimination on the grounds of age, gender and/or disability. Residents lacking mental capacity for decisions about particular matters, including health care, must be protected under the Mental Capacity Act 2005. (For a better understanding of how to apply the principles, see the Mental Capacity Act resource.)

Rights under the NHS Constitution

The NHS Constitution [8] states that:

You have the right to be involved in discussions and decisions about your health and care, including your end of life care, and to be given information to enable you to do this. Where appropriate this right includes your family and carers.

This right extends to residents in residential and nursing homes. It also promises:

To offer you easily accessible, reliable and relevant information in a form you can understand, and support to use it. This will enable you to participate fully in your own healthcare decisions and to support you in making choices. This will include information on the range and quality of clinical services where there is robust and accurate information available (pledge).

Many residents have multiple long-term conditions relating to their physical, mental and psychological health, and require proactive care and active protection from age discrimination. Participants in the SCIE Practice Survey, 2013 raised the issue of age discrimination within the NHS: they felt professionals could be reluctant to put themselves out for an older person, either because they lacked the expertise or they felt it was a waste of their time. Proactive GP involvement benefits not only medical and medication reviews, but also clinical planning and assessments to facilitate proactive and preventative medical care and end of life care.

In our study, there were significant differences between dependency, cognitive function, behaviour, nutrition, medication and use of services between nursing and residential care homes. However, residents of both types of homes had profound dependency and frailty. There seems no evidence-based rationale for rationing access to healthcare resources on the basis of residence in one type of home or the other, as has been reported by other researchers to occur commonly in clinical practice. [14]

Reluctant clinicians and poor-quality medical services

In surveys and some qualitative studies, care home staff often express satisfaction with the services and support provided by GPs, and report that most GPs do visit when asked to. However, in several qualitative studies, care home staff and relatives report individual GPs' refusals or reluctance to visit on request; a lack of interest in the medical care of care home residents; a lack of interest in participation in end of life planning; and/or a lack of interest in providing anticipatory care and medication, medical equipment (e.g. syringe drivers and venepuncture kits), and other services to care homes, or in working in partnership with care homes.

Care home managers can facilitate continuity of care where there is high turnover and shift working, such as a change of GP or other health care professional. Difficulties reported with GP or medical out of hours services for care homes include a lack of communication; a lack of out of hours visits to the care home; a lack of knowledge of residents; difficulties in obtaining medication, linked to a lack of anticipatory prescribing by GPs; and having no access to adequate medical records. Qualitative studies report inappropriate hospital admissions, and harm caused by prescribing errors, as a result of the actions of out of hours services and other doctors who do not know residents' medical histories.

Health inequalities

I think we should have specialist GPs that have an interest in older people. That are paid maybe to just look after older people. Who would be clinical specialists, I mean and community matrons. We don't have any tissue viability specialists coming into nursing homes, we don't have any dieticians. We have people who are on complete bed rest who have to be transferred to hospital once a year to do their PEG; it doesn't make sense. These services should be in the community, we don't have access to them of any kind. We have no diabetic nurse.

Care home manager [46]

Care home managers can ask for GPs to lead medical reviews, medication reviews, clinical planning and assessments, which facilitate proactive medical care. They should also be aware of other services available locally to which GPs can refer residents. Twenty-five per cent of NHS trusts surveyed in 2008 reported inequality of access to physiotherapy and occupational therapy, and 35 per cent to district nursing. Fifty-seven per cent of residents in a 2009 CQC survey were unable to access all health care services required. [27]


All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:

Available downloads:

  • Evidence review on partnership working between GPs, care home residents and care homes
  • GP services for older people: a guide for care home managers
  • Improving access to and experience of GP services for older people living in care homes: practice survey