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GPs denied resources to cope with care homes

By Lilian Anekwe

Exclusive: GPs are being forced to shoulder the burden of managing patients in care homes with inadequate funding and in many cases without access to basic support services, Pulse's special investigation reveals.

Just 44% of primary care organisations provide any funding through local enhanced services to cover the extra workload from nursing and residential homes, and even that money is not safe, with just 37% committing to LESs for next year.

Half of primary care organisations are expecting GPs to conduct reviews of antipsychotic medication without any additional funding, and 38% of PCOs commission no support for GPs from community pharmacists to ensure patients' medicines are managed safely.

A significant minority of the 100 PCOs responding to Freedom of Information Act requests do not provide even basic care-home services, with 14% providing no access to tissue viability nursing, and 10% have no access to continence advisers.

The investigation, which involved submitting three separate FOI requests to each PCO, reveals the patchy nature of services across the NHS, as well as the headline findings of soaring numbers of serious incidents and sharp funding cuts.

More than two-thirds of GPs told an accompanying survey they felt funding for practices to cover their local nursing and residential homes was not adequate to provide a ‘safe and effective' level of care.

The poll of 170 GPs found 61% did not feel the arrangements for the medical and nursing care of patients care homes were organised satisfactorily.

Some 39% described their access to geriatricians or specialist nurses as poor or very poor, and a third called for PCOs to employ dedicated GPs to oversee the medical care of care-home residents. A third of GPs said they were aware of cuts to services for care-home residents in the last year.

Dr Helen Hosker, a GPSI in old-age medicine in Manchester, said: ‘Problems with care homes are very unevenly distributed between practices. We are getting an ever increasing number of frail ill elderly with no financial resource or support. We need specialist support from geriatricians, and old-age psychiatrists to deal with patients, because so many of them have dementia as well.'

Dr Krishna Chaturvedi, a GP in Westcliff-on-Sea in Essex, said: ‘Our practice has served more than 10 residential homes for 20 years but due to the increasing stress, we decided to take all homes off the list after making several pleas to the SHA and PCT for extra support, none of which was forthcoming.'

GPs in our survey made a clear call to action. When asked what the priorities were for improving the care of patients in care homes:

• 69% said better qualified nurses were needed and

• 41% called for PCTs to establish dedicated nursing teams to do care planning and medication reviews.

• 69% called for improved reimbursement of practices for care

• 52% called on PCOs to offer LESs to encourage close GP involvement in care homes,

• 56% said they needed better access to geriatricians and specialist nurses

• 34% said PCOs should employ dedicated GPs to oversee care homes

Dr Helen Hosker More on...

Click here for the full results of our special investigation