A survey of access to medical services in nursing and residential homes in England.
BACKGROUND
Residential and nursing homes make major demands on NHS services.


OBJECTIVE
To investigate patterns of access to medical services for residents in homes for older people.


METHODS
Telephone survey.


METHODS
All nursing and dual registered homes and one in four residential homes located in a stratified random sample of 72 English primary care group/trust (PCG/T) areas.


METHODS
A structured questionnaire investigating home characteristics, numbers of general practitioners (GPs) or practices per home, homes' policies for registering new residents with GPs, existence of payments to GPs, GP services provided to homes, and access to specialist medical care.


RESULTS
There were wide variations in the numbers of GPs providing services to individual homes; this was not entirely dependent on home size. Eight percent of homes paid local GPs for their services to residents; these were more likely to be nursing homes (33%) than residential homes (odds ratio [OR] = 10.82, [95% CI = 4.48 to 26.13], P<0.001) and larger homes (OR for a ten-bed increase = 1.51 [95% CI = 1.28 to 1.79], P<0.001). Larger homes were more likely to encourage residents to register with a 'home' GP (OR for a ten-bed increase = 1.16 [95% CI = 1.04 to 1.31], P = 0.009). Homes paying local GPs were more likely to receive one or more additional services, over and above GPs' core contractual obligations. Few homes had direct access to specialist clinicians.


CONCLUSIONS
Extensive variations in homes' policies and local GP services raise serious questions about patient choice, levels of GP services and, above all, about equity between residents within homes, between homes and between those in homes and in the community.
National Primary Care Research and Development Centre, University of Manchester.
Caroline
C
Glendinning
Sally
S
Jacobs
Alison
A
Alborz
Mark
M
Hann
D000368:Aged; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D013222:State Medicine