title: Explaining the barriers to and tensions in delivering effective healthcare in UK care homes: a qualitative study.
abstract: OBJECTIVE
  To explain the current delivery of healthcare to residents living in UK care homes.
  
  
  METHODS
  Qualitative interview study using a grounded theory approach.
  
  
  METHODS
  6 UK care homes and primary care professionals serving the homes.
  
  
  METHODS
  Of the 32 participants, there were 7 care home managers, 2 care home nurses, 9 care home assistants, 6 general practitioners (GPs), 3 dementia outreach nurses, 2 district nurses, 2 advanced nurse practitioners and 1 occupational therapist.
  
  
  RESULTS
  5 themes were identified: complex health needs and the intrinsic nature of residents' illness trajectories; a mismatch between healthcare requirements and GP time; reactive or anticipatory healthcare?; a dissonance in healthcare knowledge and ethos; and tensions in the responsibility for the healthcare of residents. Care home managers and staff were pivotal to healthcare delivery for residents despite their perceived role in social care provision. Formal healthcare for residents was primarily provided via one or more GPs, often organised to provide a reactive service that did not meet residents' complex needs. Deficiencies were identified in training required to meet residents' needs for both care home staff as well as GPs. Misunderstandings, ambiguities and boundaries around roles and responsibilities of health and social care staff limited the development of constructive relationships.
  
  
  CONCLUSIONS
  Healthcare of care home residents is difficult because their needs are complex and unpredictable. Neither GPs nor care home staff have enough time to meet these needs and many lack the prerequisite skills and training. Anticipatory care is generally held to be preferable to reactive care. Attempts to structure care to make it more anticipatory are dependent on effective relationships between GPs and care home staff and their ability to establish common goals. Roles and responsibilities for many aspects of healthcare are not made explicit and this risks poor outcomes for residents.
authors.affiliation: Division of Rehabilitation and Ageing, Queens Medical Centre, School of Community Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Isabella
authors.initials: I
authors.lastname: Robbins
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.forename: Jane
authors.initials: J
authors.lastname: Dyas
authors.forename: Philippa
authors.initials: P
authors.lastname: Logan
authors.forename: John
authors.initials: J
authors.lastname: Gladman
keywords: Primary Care; Qualitative Research