Safety warning as GP nursing home service faces closure

A dedicated GP service for nursing home patients is being closed down by a health board in Scotland, prompting fears that patient care will suffer.

Care home residents: GP service concerns
Care home residents: GP service concerns

NHS Greater Glasgow and Clyde has said it intends to shut the Nursing Homes Medical Practice (NHMP), which provides GP services to around two-thirds of nursing homes in the city and to some in surrounding areas.

The health board intends to replace the service with a local enhanced service (LES) across the area, but Dr Mike Adamson, one of the GPs who works for the service, said patient care for nursing home residents within Glasgow will decrease, although the service may improve across Clyde.

The NHMP was created in 2002, just for Glasgow, originally with eight GPs. Dr Adamson said the service had been run down to its current staffing level of two full-time GPs and two part-time doctors. A number of ‘assisting practices’ also provide care for nursing home patients.

Alternatives reduce service

At least one area in Scotland operates a LES for care of nursing home patients, in Lanarkshire, and a number are being created in England. But Dr Adamson said they were unable to provide the same level of care as a dedicated service.

‘Local enhanced services do not provide the same quality of care as a dedicated service,’ he said. ‘Lanarkshire has a LES, and it does not provide the same quality of care as The NHMP. It would be really ironic if the very first dedicated nursing homes practice in the UK was done away with.

'We reduce ambulance and out-of-hours call-outs, and, together with our pharmacy team, we reduce spending on drugs. There will be no pharmacy team after 31 March, it will all be done by the new LES GPs.’

Under the LES proposals, which are due to be introduced in April next year, the health board would be able to access central funding from the Scottish government for treating patients in deprived areas.

Enthusiasm low

But Dr Adamson said: ‘There is very little enthusiasm for the LES among GPs. Two assisting practices have resigned, and one has cut down from five nursing homes to two.’

GPC deputy chairman Dr Richard Vautrey said provision of GP care to nursing home patients was a growing issue for many practices across the UK because the workload involved was considerable.

‘Some areas have developed LESs to support this work and that has enabled practices to expand their team to create the capacity and expertise necessary to provide good care,’ he said.

‘More CCGs need to follow this lead as too many practices are left struggling to cope with this growing demand, and core funding does not adequately meet this need.

‘The problem is that dedicated teams separate to the practice risk fragmenting care and losing the holistic role that good general practice offers.’

In a statement, NHS Greater Glasgow and Clyde said its Ageing Population Group identified a need ‘ensure equitable access to healthcare’ in 2012.

‘Following the review of the service, proposals have been developed to create a standard and equitable service for medical, nursing, prescribing and AHP support to residents in nursing homes throughout Greater Glasgow and Clyde.

‘The new LES will be underpinned by a set of service standards that will ensure that all residents across the health board area receive the same high quality service and will include an increase in the number of specialist care home nurses across Greater Glasgow and Clyde.  

‘We have engaged with a range of stakeholders including local authorities, care home representatives and primary care colleagues through our six Community Health Partnerships.’

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