GP services for older people: a guide for care home managers
Residents' entitlements and requirements - Registration with a GP
For a resident to receive good quality general medical services, primary health care and access to the rest of the NHS, it is essential for them to be registered with a GP.
The revised NHS Constitution  guarantees everyone the right to receive NHS services, free at the point of need and to access NHS services without being refused on unreasonable grounds. People are not excluded from these guarantees because they live in a care home. GPs can undertake to provide enhanced services to the residents of a care home, but this provision is arranged and funded through the NHS.
Under the NHS Constitution, individuals also have the right to choose their GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse. There are reports in the literature of individual GPs resisting or refusing to register a care home resident. Home managers taking part in the SCIE's Practice Survey confirmed that this remains a problem with some practices.
I have to fight every time I go to register a resident. Basically, GPs don't want to take an older resident on because they cost too much in time, in resources, in medication, supplements, whatever, so it's very difficult to get to register an older person with a GP.Care Home Manager 
A new resident should be involved, with their relatives where appropriate, in the decision about whether to remain registered with their current GP practice, or transfer to the list of a GP practice with which the care home has arrangements for cooperation, joint working and/or enhanced services. The option to stay with a GP the person knows partly depends on whether the care home is still within their practice boundaries. In some instances, though, the GP will choose to continue providing medical care to a patient they know well, despite the greater distance.
The home manager, together with the social worker or care manager, if one is involved, should take steps to help the resident and relatives make an informed decision. They can provide information and advice on the pros and cons of maintaining an established doctor-patient relationship, or benefiting from a care home's liaison arrangements with one or more local practices, which may include an enhanced services agreement.
The care home and general practice can both provide information for residents and relatives to clarify:
- roles of primary care and other health professionals
- how residents register with a GP (and who is responsible for doing this), entitlements to basic services, any enhanced services and how residents can exercise choice
- how the care home makes the decision to contact a GP, and how they obtain feedback on the outcome of GP visits.
Some care homes have found, and residents have confirmed, that a GP who visits regularly and is familiar with the residents has a beneficial impact. The GP may have a better understanding of any current medical needs within the context of previous and future health needs.
All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:
- 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