A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes

What is it about?

The general practitioner is doctor responsible for medical care of older people who live in care homes, in the UK. Care homes include residential and nursing homes, known internationally as long-term care facilities or residential aged care facilities. Ideally this should involve integrating with a team of care staff and other healthcare staff to provide comprehensive care. We aimed to explore how GPs learn to provide this type of care and how training could be improved. We talked with trainee GPs as well as senior GPs, who supervise trainees, in order to understand current training and need for improved training to address the challenges of providing integrated care. We heard from GPs that there was no specific training on how to work with care homes. Trainees on placement had variable levels of attending care homes, and some GP practices may have no associated care homes. We heard from senior GPs that they felt a sense of challenge and risk in providing care within care home because these were independent organisations from the GP practice. We interpreted our findings using theory of negotiated order, which aims to explain social interactions which negotiate the barriers of traditional hierarchies. Thus we interpreted where trusting relationships were present between GP and care home staff, the sense of risk that the GP may feel about providing treatment to the resident could be mitigated by input and reassurance from care staff. We noted that care plans could be a way of formalising these arrangements between different members of the care team. Care plans mentioned were either for long-term care or end-of-life care. In conclusion, we found a need to provide training specific for delivery of care to older people living in care homes. This would include training about how GPs should engage with care homes as organisations, rather than attending to a list of patients. Training should encourage GPs to build trusting relationships with care home staff, to facilitate listening to the input from the care staff and team and contribute effectively to person-centred integrated care.

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