Addressing the problems associated with general practitioners' workload in nursing and residential homes: findings...

Caring for older people in residential and nursing homes makes major demands on general practitioners (GPs).

To investigate the perceptions and experiences of home managers and GPs of the provision of general medical services for older residents.

In-depth qualitative study.

Forty-two nursing and residential homes in five locations in England, interviewing home managers and eight of their residents' GPs.

Semi-structured face-to-face and telephone interviews.

Most homes endorse principles of continuity of care and patient choice. Although many homes therefore deal with a large number of GPs, with the inherent difficulties of coordinating care and duplication of GP effort, limitations in residents' choice of GP result in the majority of residents in many homes being registered with only one or two practices. Contracts between homes and GPs may provide opportunities for improving medical care but do not guarantee additional services and have implications for patient choice and residents' fees. Visits on request form the bulk of GPs' workload in homes but can be hard to obtain for residents and may not be appropriate. Regular weekly surgeries are preferred by many homes but may have additional workload implications for GPs.

The assumption that patient choice and continuity in medical care are paramount for older people in nursing and residential homes is questioned. While recognition of the additional workload for GPs working in these settings is necessary, this should be accompanied by additional NHS remuneration. Further research is urgently required to identify which models of GP provision would most benefit both residents and GPs.