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McMurdo and Witham emphasise the role of secondary care in supporting primary care teams and care home staff in providing good quality care for older people in nursing and residential homes.1 As a general practitioner with responsibility for 50 patients with dementia in a specialist nursing home, I recognise that practical steps taken in primary care can have a major impact on the standard of care we offer to our patients.
Seven years ago I presented an alternative to the reactive (“firefighting”) approach to patients in care homes to my partners. Since then we have taken personal responsibility for a care home each, managing the long term health issues of our patients and building constructive relationships with the staff and management at the six homes (142 patients) we look after.
Auditing the factors affecting emergency admissions of patients from care homes has also allowed me to challenge the approach of the local out of hours provider. In particular, the “dial 999” response to an acute problem, which resulted in 75% of patients being admitted without being visited and assessed out of hours (the corresponding figure being 25% in general practice hours) over 12 months from our six local care homes. I have also presented the general practitioners in Peterborough with the arguments in favour of a named general practitioner from a committed practice taking on responsibility for the care of all the patients in a particular care home. Historically in Peterborough, patients have not changed doctors on entering a care home. This has resulted in practices with small numbers of patients in as many as 17 different care homes across the city, and care homes consequently needing to liaise with up to 70 doctors in 17 different practices.
Competing interests: None declared.