Time to change care home resident management: reflections on a GP-led service.

Abstract

Over the past few years, there have been numerous discussions on shared experiences with many GPs, care home staff, managers, and some patients. These have demonstrated a largely shared view that the current model for providing primary care to care homes can be suboptimal and haphazard, and is an inefficient use of primary care resources. Various alternative models exist,1 including dedicated GP-led services, matron- or district nurse-led services, or attaching a care home to an individual practice. The evidence base for the impact of such models on patient outcomes and on cost-effectiveness is, to date, patchy. A new approach is needed if we are to meet the needs of care home residents. Patients usually remain with their own GP when they move into a care home, provided that care home is in the GP’s catchment area. A common expectation is that the GP is readily available to deliver all primary care (acute and chronic disease management) within the care home setting. Home visits to multiple care homes may result in suboptimal medical care due to limited facilities and inefficient use of several GPs’ time. Still, this model of care persists, even though many patients attend secondary care appointments in hospital through the support of family, staff, charitable, NHS, or private transport services. Primary care for this population tends to be reactive, responding to problems as they develop. This reactive approach, coupled with suboptimal utilisation of the care home staff’s skill set, contributes to high rates of unplanned admissions and an unpredictable workload for GPs. Issues that contribute to the strain on the current system include: