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

Managers' responsibilities and the NHS reforms - Development of a medicines strategy

Care homes should work with their GPs and pharmacists to develop a strategy for medicine management, including regular (e.g. six-monthly) medication reviews conducted by GPs and/or pharmacists. Managers should consider with GP practices how to address medication issues in order to reduce high levels of serious prescribing error, and have a plan to obtain medication out of hours through liaison with GPs and pharmacies.

The home manager's role in developing a medicines strategy

The care home manager can take a lead role in identifying the health care needs of residents, and discussing preferences with residents and/or family members and GPs. [26] The manager acts as an advocate for residents and takes a leadership role in relation to medical plans.

Various studies [16, 22, 26] and one report [12] note the importance of leadership or 'persistence' from the care home manager and other care home staff in their relationship with GPs and other health professionals in the multidisciplinary context, and in supporting health care regimes and decisions made by health care professionals.

In two examples, a care home manager prepared medication forms for each resident at her own initiative, to be used in joint medication reviews involving the GP and community pharmacist. [26] The SCIE Practice Survey [46] carries an example of a care home that had been involved in designing the pre-admission assessment form, 'so it had the information we need to provide proper care'.

Relatives and carers in one study [22] suggested that care home managers and staff should take the role of 'medication champions' in the context of managing medication and reducing prescribing and dispensing errors in care homes. In homes having a key worker for each resident, the key worker can be formerly responsible for medication issues and for updating family and carers about any changes.

Two major studies found that about 40 per cent of residents had a prescribing error, linked to harm in some cases, compared to 11 per cent having a monitoring error, 22 per cent having an administration error and 37 per cent having a dispensing error. The prescribing errors were 'incomplete information' in 38 per cent of cases, 'unnecessary drug' (24 per cent of cases), 'dose/ strength error' (15 per cent) and 'omission' (12 per cent). [40, 41]

Medication and broader health reviews

The evidence indicates that the practice of GPs in relation to medication reviews for residents, and broader reviews of their health status, advance care plans and end of life plans, is very variable:

Reported beneficial outcomes from medication reviews include:


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