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

GPs' role in relation to the resident, the home and the wider NHS - GP relationships with their patients in care homes

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.

because really the contract's between you and the patient, not you and the home.

GP [28]

I'm 92 you know. Before I came here (to the nursing home) I used to see Dr B. He knew me for 30 years and saw me through all my traumas. He used to phone me up to have a chat and I liked that. When I moved here, I didn't want to drag Dr B. here so I'm registered with the one from here... I'm happy with my medicines. They work. If I wanted to see a GP I could because I've got a mouth and I know how to make myself heard.

Resident [46]

The assertive patient

The concept of the 'assertive patient' emerged from listening to residents taking part in the SCIE Practice Survey. [46] They were clear that they received services they were entitled to if they, or the people advocating on their behalf, were assertive or persistent.

Care home managers and their staff can help residents to be more confident in relating to visiting GPs. Positive relationships between GPs and individual residents and family members (GPs 'getting to know' them) are reported by residents, GPs and care home staff to be associated with positive outcomes. These include residents feeling reassured and listened to, understanding their medical issues and being encouraged to take medication or cooperate with treatment; GPs following residents' wishes for treatment and care; and reductions in hospital admissions. [12, 24]

Fostering good relationships

Views differ among care home managers about how to foster good relationships between GPs and residents. A qualitative evaluation found that an enhanced service scheme and preferred practice arrangement with regular scheduled visits by GPs encouraged positive relationships between GPs and individual residents and family members. [24] However, in the SCIE focus groups and questionnaires, arrangements where some residents continued using their own GP were also reported to lead to good relationships between the GPs, 'their residents' and the care home staff. The manager of one care home in an urban setting felt there were benefits in several GP practices visiting and caring for residents in the home, rather than being dependent on one practice. Another reported that, of the five practices local to the home, two were better to work with than the others. New residents who did not wish to remain with their own GP were encouraged to register with one of the more supportive practices.

Research studies indicate that residents, relatives and care home staff notice and appreciate it when GPs and other professionals are respectful, sensitive, friendly, understanding and kind in their relationships with residents. [22, 24, 29] Conversely, they find it distressing when GPs are dismissive, aloof or disrespectful. [22] GPs' lack of knowledge of individual residents is raised as an issue in studies, and is associated by research participants with outcomes such as inappropriate hospital admission and medication errors.


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