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

Residents' entitlements and requirements - Information shared appropriately

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.

Dr Andrews is absolutely brilliant. He may not be able to solve all the problems but I am intelligent and I understand him. Only a month ago he discovered why I got paralysed and he was able to discuss it all with me and I now know what it means.

Resident [24]

Emergency call-out doctors do not know residents, so play safe and order them to be admitted to hospital for many conditions which could perhaps be resolved differently.

Resident [25]

Good practice in information-sharing

In its report on 'Health care in care homes', [10] the CQC found that three-quarters of homes included in the review provided staff with training on the sharing of personal information. However, interviews with residents suggested that although most felt that their information was kept private, many did not feel that staff asked them for their permission before sharing information more widely.

Among residents in care homes, medical interventions and hospital admissions often arise at short notice or in emergency conditions, perhaps following a fall and/or injury. In the urgency of dealing with the immediate situation, it is not always easy to make sure information about a resident's wishes and intentions is known and conveyed. It may not even be formally recorded, but is only part of the informal discussion among staff, or shared at shift handover meetings. A clear record can make a difference to residents, particularly if they are distressed, injured or unwell, so that key professionals are aware and take notice of their wishes.

These problems can be reduced by following the British Geriatric Society's advice to:

arrange a holistic review for any individual within a set period from their move into a care home, leading to healthcare plans with clear goals. This will guide medication reviews and modifications, and clinical interventions both in and out-of-hours.

British Geriatrics Society [45]

The Society also recommends that:

Care home residents should be at the centre of decisions about their care. An integrated social and clinical approach should support anticipatory care planning, encompassing preferred place of care and end of life plans.

British Geriatrics Society [62]

If a resident relates to or communicates well with particular staff, they may share conversations about important personal concerns, like worries about relatives, admissions to hospital, or wishes about end of life care. Staff should know how to respond to this information, which may at first be communicated on a private or confidential basis. The manager should support and guide staff, perhaps with a general procedure as well as advice about individuals. An appropriate response may be for the staff member to ask the resident's permission to record the information securely, so that it is available and can be referred to in the event of an emergency.

Care plans

Care home managers can play a leading role in identifying residents' health care needs, acting as advocates for residents, and discussing residents' preferences with family members where appropriate, as well as with GPs. [26] They or a designated senior can act as an advocate for residents, and in a leadership role for implementing medical plans.

Care home managers and senior staff need to ensure access to care plans by all involved, including out of hours services and locum GPs. The residents' records should be well organised, making it easy both to assess their ongoing personal care and support, health care and treatment, and to identify recent changes in demeanour, behaviour or capacity which may help the GP's understanding and assist diagnosis.


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