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NHS must defuse care-homes time bomb

Pulse’s investigation this week reveals just how serious the problems are in the UK’s care homes, and how superficial are the attempts by ministers to solve them.

Pulse's investigation this week reveals just how serious the problems are in the UK's care homes, and how superficial are the attempts by ministers to solve them.



It isn't only patients who can send the heart sinking. Whole areas of patient care can too. Just like any other segment of society, general practice has its sink estates, its apparently intractable problems that when discussed prompt a sigh and a tightening of the chest. The care of patients in nursing and residential homes is one.

Pulse's investigation this week reveals just how serious the problems are in the UK's care homes, and how superficial are the attempts by ministers to solve them by knee-jerk clampdowns on GP prescribing.

The UK has a rapidly ageing population and the numbers of care-home residents are increasing. Yet we found funding allocated for their care has been cut by 11% in a year, as primary care organisations allow the country's frailest, most vulnerable patients to bear the brunt of cuts.

It would hardly be surprising, then, to see evidence of a decline in quality of care. What is shocking is the rate of decline, with the number of ‘critical incidents' – often triggered by sloppy or substandard care – leaping by an astonishing 80% in just one year.

GPs, of course, are well aware that patients in care homes are often not looked after adequately. A third of GPs told a Pulse survey nursing standards were poor or very poor in their area. Just half of GPs can call on the services of community pharmacists to review their patients' medication and 39% struggle to access specialists' advice.

Overwhelmingly, the profession believes the funding provided to practices is inadequate to cover the workload of managing these most difficult of patients.

The care of patients in nursing and residential homes isn't just underfunded, but also disorganised. GPs say half their call-outs to care homes are unscheduled, and they are frequently forced to make snap decisions about the care of patients in chaotic environments without access to proper information or specialist advice.

Only a fraction of PCOs – around 20% – provide dedicated support for GPs with geriatricians or specialist nurses.

Nor do the consequences affect only patients. Some 69% of GPs said management of patients in care homes was a significant source of work stress.

Of course, as with any heartsink area, it is tempting to sigh ‘twas ever thus', and avoid taking action.

That is no longer an option for GPs. In the next couple of years, in England at least, nursing cover in care homes will become their responsibility. If 1,600 critical incidents are reported, as they were last year, it will be GPs who are expected to act.

And the Government is already moving to make GPs the scapegoats for the worsening problems in Britain's care homes, as its crude threat to name and shame high prescribers of antipsychotics illustrates only too clearly.

GPs must press PCOs for action on care homes now – for proper networked care, including LES funding, specialist advice and nurse and pharmacy support.

This issue is, in the words of one GP, a ‘time bomb'. If action is not taken, it will go off right under general practice.

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