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. 2025 Apr;13(11):1-68.
doi: 10.3310/YNDV6358.

Organising general practice for care homes: a multi-method study

Barbara Hanratty  1 , Rachel Stocker  1 , David Sinclair  1 , Katie Brittain  1 , Karen Spilsbury  2 , Daniel Stow  1 , Louise Robinson  1 , Fiona E Matthews  1
Affiliations

Organising general practice for care homes: a multi-method study

Barbara Hanratty et al. Health Soc Care Deliv Res. 2025 Apr.

Abstract

Background: General practice provides first-line National Health Service care for around 400,000 care home residents. Good primary care can enhance residents' health and well-being and optimise use of hospital services.

Objectives: This study aimed to explore the relationships between organisation of general practice and the perspectives and experiences of residents, general practice and care home staff, outcomes and costs.

Design: Survey of general practices (2018), qualitative study (2019), analysis of primary care data (2019-21).

Policy context: National Health Service England Vanguard funded innovation in services for care homes in five areas (2015-8); Enhanced Health in Care Homes introduces standardised care home healthcare processes in England (2020-4).

Setting: England: national survey; qualitative work in three areas (two Vanguards); analysis of national primary care data across early implementation of Enhanced Health in Care Homes and the COVID-19 pandemic.

Participants: One hundred and fifty general practice survey respondents; 101 interviewees (general practitioners, practice managers, receptionists, care home managers, nurses, senior carers, residents, relatives, commissioners) in three areas; 103,732 care home residents ≥ 75 years, registered with participating practices in Clinical Research Datalink Aurum 2019-21.

Results: Qualitative analysis identified three themes concerned with general practitioner services to care homes: relational processes, communication and organisation. Continuity of care, sensitivity to the skills of care home staff and routines of the home, along with a willingness to dedicate time to patients, are all crucial. Different structures (e.g. scheduled visits) provide opportunities to develop effective, efficient care, but flounder without established, trusting relationships. The way in which new initiatives are implemented is crucial to acceptance and ultimate success: telemedicine was an example that generated efficiencies for the National Health Service, but could be a burden to care homes, resented by staff and perceived as a barrier to overcome. One hundred and fifty practices responded to our survey, a majority staffed by ≤ 5 general practitioners. Larger practices were more likely to have a nominated general practitioner for care homes and make weekly scheduled visits. Analysis of primary care data found that in practices with a higher number of care home residents, patients had more contacts with primary care and fewer urgent referrals. Between 2019 and 2021, total contacts and estimated costs increased, and urgent referrals and polypharmacy fell.

Limitations: Sparse evidence of systematic change in Vanguard areas limited our conclusions about specific initiatives. Implementation of national policy during the COVID-19 pandemic complicates data interpretation.

Conclusions: Larger practices or those with higher numbers of care home residents were more likely to adopt ways of working that are associated with higher-quality care. However, trusting relationships between care homes and a motivated, adequately resourced primary care workforce may be more important than models of care, in enhancing primary care for care homes. General practices and care homes find creative ways around initiatives that are not perceived to offer any benefits, emphasising the need for local flexibility when implementing national initiatives.

Future work: Future work could address how best to promote ways of working that prioritise trusting relationships; the absence of care pathways specific to care home patients, and the impact of Enhanced Health in Care Homes on system-wide costs.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/196/05) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 11. See the NIHR Funding and Awards website for further award information.

Keywords: FAMILY PHYSICIANS; GENERAL PRACTICE; LONG TERM CARE; MIXED-METHODS RESEARCH; NURSING HOMES; QUALITATIVE RESEARCH; RESIDENTIAL FACILITIES.

Plain language summary

Most people who live in care homes are older adults. General practitioners look after their day-to-day medical care, working with care home or community nurses. In England, there have been moves to improve health care for people in care homes. In this study, we looked at how general practitioner services could be delivered to get the best care for care homes. We surveyed practices, interviewed more than 100 people in three different areas of England (pre-COVID) and analysed information from electronic healthcare records in primary care using a large research database. Our qualitative study identified three areas that general practices working with care homes should focus on. These were relationships, the way care is structured, and how changes are introduced. All three need to be in place, to improve experiences and care for care home staff and residents. One hundred and fifty practices replied to our survey – around half made planned visits to care homes, and nominated one person for this work. Bigger practices were more likely to work in ways that should provide good-quality care for care homes. Our analysis of healthcare records (2019–21) showed residents in practices with larger numbers of care home residents saw their general practitioners more often and had fewer urgent referrals. Over the time that policy changes were first introduced in England, residents had more contact with practices, prescribing improved, urgent referrals fell and estimated costs went up. This study provides support for changes being introduced by national policy but emphasises the need for trusting relationships between primary care and care home staff. Future challenges include developing and retaining a skilled primary care workforce that wants to work with care homes. Care pathways to guide general practitioners and care homes when a resident is ill may also be helpful, along with more in-depth analysis of the cost implications.

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