New research on GP involvement in care homes and new NHS prescription Guidelines

A pilot scheme carried out in care homes in four London Boroughs which guaranteed residents 24/7 dedicated GP support, as well as training and advice for staff and help from a consultant geriatrician, has found that emergency hospital admissions were reduced by nearly 40%.

Under the trial scheme, each care home was allocated a dedicated GP, employed by Health 1000, a primary care practice specialising in providing GPs to care homes.

While the research showed that such a service undoubtedly worked in an urban area, it is difficult to see how it could be provided in village and rural locations, where GPs are responsible for patients over wider geographical areas.

However, here at Aveley Lodge we benefit from a GP surgery to which all our residents can be allocated.

Some of our residents come from as far away as Scotland, which makes it difficult for friends and family to visit or provide regular support.  Some residents actually have no friends or family to visit.

So, while residents can remain with their existing GP if they wish, we encourage them to register with our local, allocated practice.

This means that we can work very closely with them and can call out a GP for a visit for any concern we have about a resident and the GPs also help us when a resident needs a medication or pain relief review, a mental health assessment (in dementia cases), help with speech and language issues and help with end of life care and wishes.

Recently, we have been informed by our local Care Commissioning Group (CCG) that the NHS has issued guidance that easily-available over the counter medications such as paracetamol, aspirin, heartburn relief should no longer be prescribed on prescription.

When the move was proposed a year ago Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners (RCGP) warned: “”Imposing blanket policies on GPs that don’t take into account demographic differences across the country, or allowing flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society.”

Again, this is an issue that will affect us, in that as mentioned above, we do have residents whose family are living some distance away and could therefore not take over responsibility for making sure their loved one has a ready supply of over the counter medications.

Pharmacies also cannot issue directions for use of medications as GPs can and do when they are prescribed. If we were to take over ensuring sufficient stocks of such medications for each patient it would mean we would also have to take over labelling and storage.

However, it seems Professor Helen Stokes-Lampard’s words were heeded, and the NHS opted for issuing guidance rather than a blanket ban. And it appears that there is provision in the guidance for exceptions where a clinician believes “a patient will struggle to self-manage because of medical, mental health problems or ‘significant social vulnerability’…”.

According to the GP Magazine Pulse, this leaves the option for GPs to continue to treat patients according to their individual circumstances and needs, and that includes issuing prescriptions where there are reasons why self-care is inappropriate. This guidance does make it clear that such requirements continue to apply in individual situations.

We’ll keep you posted as the situation unfolds.