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

GPs' role in relation to the resident, the home and the wider NHS - Managing relationships

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.

We don't actually have a retained GP here as such, so they would, I mean, there are a couple of surgeries that are quite local so they're sort of like the surgeries probably of choice. But you know what I mean, at the end of the day it would be down to the resident to choose, wherever they wanted to have a GP, wherever they wanted to register.

Care home manager/owner/matron [28]

Well, I think if they've known the resident for twenty, thirty years, they should continue that. I don't see any point in changing, because they know them best. They've dealt with all their illnesses for the last X number of years. So, we wouldn't, you know, we wouldn't change, unless we were forced to for some reason.

Care home manager/owner/matron [28]

Effective working relationships

No single model for relationships and communication between care homes and GPs has received universal endorsement. Practice varies across England and even within a given locality.

A number of different models appear capable of working effectively. As with other aspects of joint and integrated working, structures and systems for improved cooperation will fail without the will to cooperate. If the parties share a commitment to working together, and preferably a shared value base, they can make most structural arrangements work.

Home managers taking part in the SCIE's Practice Survey, 2013 said that, whatever the arrangement was in practice, it should be designed to meet the health care needs of the residents, rather than being chosen primarily to suit the GP or the home. 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, use of end of life frameworks and pathways.

Close, effective working relationships between care homes and GPs are reported by care home staff, GPs and other stakeholders. These are associated with several positive outcomes including:

Factors aiding or hindering relationships

Enhanced service agreements, preferred practice arrangements, having just a few GP practices per home, regular visits and meetings, and other forms of contact are reported by residents, relatives, care home staff and GPs to contribute to and sustain positive relationships. However, in the SCIE focus groups and managers' questionnaires, the system of residents using their own GP was also reported by care homes to facilitate good relationships between the GPs, 'their residents' and the care home staff.

Research identifies a number of factors likely to enhance or detract from the quality of relationships between homes and GPs:


Several studies and reports mention the importance of effective communication in promoting better joint working between GPs and care homes; reducing hospital admissions; reducing medication errors; and resolving difficulties obtaining medication. Care home staff and GPs say that they value their contact out of hours, using a variety of media (email, fax, mobile phone), as well as having regular meetings.


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