GP services for older people: a guide for care home managers
Residents' entitlements and requirements
- Care home managers should ensure that residents are registered with a general practitioner (GP) of their choice. In order to make an informed decision, residents and their relatives may want help to consider the pros and cons of retaining their existing GP, if possible, or registering with a GP already providing services to other residents in the home. Residents lacking mental capacity to make decisions about particular matters, including health care, must be protected under the Mental Capacity Act 2005.
- Providers and managers of care homes should take the necessary steps to ensure residents have appropriate, high-quality GP and primary care services readily available to them. These include daytime and out-of-hours general medical services (GMS) commissioned by NHS England area teams, and enhanced medical services commissioned by their local clinical commissioning group (CCG). Current variable standards need to be identified and harmonised by primary care leads in area teams. Quality of life and good end of life care are of particular importance to residents and relatives.
- All professionals should treat each resident as a person with experiences, aspirations and opinions, and not make assumptions about their capacity based on their age. People should be involved as fully as they wish in discussions about their health care and treatment. Provision of health services should be responsive to the needs of individual care home residents and reflect their wishes and preferences.
- Care homes should ensure that residents understand why information about their health is shared with other professionals and their consent should be sought. Health and care professionals should listen, explain and discuss health and care matters with residents, and their relatives and carers. Information-sharing between professionals should contribute to improved health outcomes for individual residents.
- Managers should make sure that residents have their human, civil and statutory rights 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.
Managers' responsibilities and the NHS reforms
- Care home managers should establish ways of listening to and regularly checking the views and experience of residents and relatives regarding their medical care. Managers and care staff can take leadership and advocacy roles in relation to the health care needs and preferences of residents, relatives and carers. Managers and GPs should ensure that local pharmacists, dentists, opticians and hearing services, CCGs and NHS England area teams understand the needs of their residents.
- Care home managers should ensure that accurate, up-to-date, consistent records are kept on medical conditions, health care and medications. Residents who wish to have access to their health records have a right in law to do so, with assistance if their capacity requires it, and may wish to make their own entries in the record.
- Care homes should work with GPs and pharmacists to develop a strategy for medicines management, including regular (e.g. six-monthly) medication reviews conducted by GPs and/or pharmacists. Managers should consider with GPs how to address medication issues in order to reduce high levels of prescribing error, and have a plan to obtain medication out of hours through liaison with GPs and pharmacies.
- Care homes should ensure that they and their care staff are familiar with the new NHS structure and integration arrangements, especially in relation to what has been agreed locally. They should know how complaints and challenges are handled. Networking, joining local forums and service development groups could all be seen as part of their advocacy role at a strategic level.
GPs' role in relation to the resident, the home and the wider NHS
- A GP's primary relationship should be with the resident who is their patient, rather than with a care home. Working in partnership with the home is, however, essential to providing a good-quality service to residents. Practice suggests that good relationships between GPs and residents are built up through regular contact and respectful, interpersonal communication which builds trust and confidence.
- GPs should be proactive in offering residents the wide range of diagnostic and therapeutic services in primary care, and full access through referral to acute and specialist hospital-based physical and mental health services. These can all contribute to maintaining each resident's health, wellbeing and independence. GPs should be aware that access to secondary services (e.g. mental health services) may be a problem for older people in care homes.
- Care home managers and GPs should agree how to handle relationships, communications and joint working between the home and the practice, to deliver what works best for residents. Issues to be considered include GP availability and interest; alignment of practices and homes; continuity, joint protocols and role clarity; and development of shared understanding through, for example, the use of end-of-life frameworks and pathways.
- Care homes and primary care providers should recognise and support the role that nurses in care homes and GP practices can play in facilitating communication between homes and GPs. This includes practice nurses undertaking initial assessment visits and nurses in homes raising professional concerns. Nurse practitioners and other senior nursing staff can share up-to-date knowledge and skills with nursing and care staff in homes, and with residents and relatives.
Workforce development, standards and regulation
- Managers and proprietors should ensure that care staff are trained and supported to be aware of and understand the medical and health needs of residents, and respond appropriately. This has implications for leadership and culture in the care home; raising staff awareness of residents' health needs; and provision of training and staff development opportunities.
- Managers and owners should be aware, and inform their staff, of the Care Quality Commission's (CQC) requirements on care home providers. This applies in relation to the health care of residents and requirements of NHS England and the CQC on GPs in relation to the care of older people.
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