GP services for older people: a guide for care home managers
SCIE's Practice survey, 'Older People living in care homes access to and experience of GP services' was carried out between February and May 2013. Three focus groups of care home managers from the voluntary, not for profit and private sector were formed. In addition, there were visits to a number of sites to talk to residents, relatives, managers and care staff.
Summary of key points:
- Care home residents reported that they were happy with the service they received from GPs, feeling that GPs took the time to listen to them and understand the specifics of their situation. Nevertheless, few residents reported regular contact with their GPs.
- The home managers described a wide range of practice in the ways in which older people in care were able to access GP services, and often in the standard of service received. Managers spoke of a postcode lottery, but it is also clear that services can vary widely even within one area.
- Managers of homes that use local enhanced GP services (an arrangement funded by the primary health care trusts) mostly reported that this system was working well, with the closeness between the home and a given practice seen as beneficial. However, there were also arguments put forward for why older people in care should continue with their existing GP, particularly because the GP has a longer-term knowledge of the person and their wider family. Some people noted how upsetting it could be to have to break off a long-standing relationship with a GP on being admitted to a home, and would have liked to keep their existing GP.
- The key factors seen as promoting joint working between care homes and GPs were establishing good communication and building a close working relationship. The majority of home managers reported that they had a good, very good or excellent relationship with the individual GPs they worked with. Regular meetings and reviews with GPs were felt to be important in achieving this, although not all GPs were willing to do this. Care home residents or relatives rarely reported any kind of fixed or regular GP reviews.
- Although home managers emphasised their close relationship with some GPs, this could cause difficulties when that GP was not available. One major problem reported was working with locums or out of hours GP services, where knowledge about individual residents was lacking, often leading to unnecessary hospitalisation.
- There was a wider problem reported by home managers regarding record-keeping and the way information was shared between the home and other health professionals. It was felt that there could be a greater role for technology in ensuring better practice in this area.
- Home managers reported that district nurse teams often provided the main link between care homes and GP surgeries. This could work well and provide a level of continuity of care, particularly if direct contact with GPs was difficult. Nevertheless, as with GPs, the quality and cooperation of district nurse services could vary widely, causing some difficulties.
- There was a sense among home managers, particularly those within the private sector, that some health service providers saw care home residents as already receiving a level of care within the home, and therefore viewed them as a lower priority compared with those in the wider community. This was particularly the case with mental health services.
- Homes often did not have specific mechanisms in place for collecting the perspectives of residents and their relatives on access to and experience of GP services, although this subject was often covered in broader quality assurance forms and CQC surveys. Residents mostly reported a very positive experience of GP services, although home managers did note that this was a growing cause of complaint for some relatives of residents.
- Managers of homes reported that they would like a clearer protocol or agreed definition, at national or local level, of what services should be on offer from every general practice, and clearer information on how to access these services.
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