Over the past 18 months, GPs across Gloucestershire have been delivering an ‘enhanced service’ for older people living in care homes. The results have significantly improved the quality of care provided, and we have also seen a fall of around 25% in the number of residents attending hospital and a reduction of around 5% in unscheduled admissions.

Nearly all of the county’s GP practices signed up to the initiative (the Gloucestershire Care Home Enhanced Service), which sees them making regular, planned visits to local care homes, delivering more personalised care for each resident.

The service specifically aims to build on the relationships between GPs and care home staff to ensure that the right care is provided when it is needed. More importantly, it means that decisions taken about peoples’ care can reflect the wishes of the residents and their families.

The GP also assesses every new resident who is admitted to the care home and carries out six-monthly reviews to ensure the patient’s care plan is continuing to meet their needs. Medications are also reviewed regularly to ensure quality and safety of care.

Dr Bob Hodges, who led on setting up the service for NHS Gloucestershire Clinical Commissioning Group (CCG) said:

“This has been a really successful example of partnership working between GPs and care homes in Gloucestershire. The enthusiasm and energy with which this new service has been taken up, despite ever increasing workload and demands on health services, has been remarkable.

It has enabled us to develop strong and positive relationships with homes, and by getting to know the staff, residents and their families, we can pick up on any changes or deterioration in a resident’s condition promptly and ensure that the care we deliver is consistent with the expectations of each person we’re looking after.

This is reducing the risk of residents reaching crisis point and needing admission to hospital, which can be distressing for residents, staff and relatives.

We are really pleased that the evaluation has demonstrated such a significant reduction in unplanned attendances and admissions. This is really helping our busy Emergency Departments during the difficult winter months.”

Dr Hein Le Roux, Clinical lead for Older People at the CCG explained:

“This is about providing more proactive and planned support to care homes. By working more closely with care home staff, GPs can answer questions, share knowledge and provide information about useful tools and training opportunities.

If a resident is admitted to hospital unexpectedly, we can look into the reasons for this, and share any lessons we learn with colleagues. We can also help to ensure that a resident’s wishes for end of life are adhered to.”

Suzanne Dutch, Manager at Charnwood House Nursing Home in Gloucester said:

“The system is more efficient as our nurses know when the GP is coming to the home. Calls to the out of hours services have decreased, as have visits to hospital. This is due mainly to the fact that the GP visits at least fortnightly to review the residents, so non urgent consultations can be planned.”

NHS Gloucestershire Clinical Commissioning Group has worked closely with Gloucestershire Care Providers Association and Gloucestershire County Council to implement the service.

There has also been positive reporting from Care Homes about their relationship with the GP surgery and the impact of the enhanced service.

Anouska Currie, Nursing and Residential Representative at Gloucestershire Care Home Providers Association, said:

“Gloucestershire Care Providers Association has received a positive response from care homes across Gloucestershire to the enhanced GP service. It is building positive working relationships between GPs and care homes and improving the continuity of care, which benefits the service users’ well-being and enables care homes to work more efficiently.”

The CCG now plans to continue the scheme on a business as usual basis, with a few changes to streamline the process and to link with other local initiatives such as the Older People’s Assessment and Liaison Service (OPAL) run by the Elderly Care physicians at the hospitals.