The general practitioner and older people: strategies for more effective home visits?

Abstract

This paper is based on findings from a pilot research project funded by the Primary Health Care Development Fund in Scotland. The researcher’s remit was to examine home visiting patterns by general practitioners (GPs) to older people on Tayside following the community care reforms. Fieldwork was conducted in three general practices on Tayside, using an anthropological perspective. This research confirms that community care changes have not to date effected a significant shift in GP perceptions, which are that the probable destiny of frail older people is to enter some kind of residential setting. The researcher examines how and why GPs label certain patients as a ’problem’ and uses this categorization process to suggest that such patients are seen by GPs as having a ’moral career’. It is argued that GPs may also see some older patients as a ’problem’, the solution to which may be to recommend that the patient enter residential or nursing home care. The research identifies a point in the career of the older ’problem’ patient at which doctors could usefully refer to other agencies. A model for communication or collaboration is posited as a way of enabling GPs to continue to provide sensitive and individually appropriate care for frail older patients in collaboration with appropriate others. Funding has been obtained to pilot this model in selected general practices on Tayside in 1996/97.