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Provision of NHS generalist and specialist services to care homes in England: review of surveys

  • Steve Iliffe (a1), Susan L. Davies (a2), Adam L. Gordon (a3), Justine Schneider (a4), Tom Dening (a4), Clive Bowman (a5), Heather Gage (a6), Finbarr C. Martin (a7), John R.F. Gladman (a8), Christina Victor (a9), Julienne Meyer (a5) and Claire Goodman (a10)...

The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.


To critically evaluate how the NHS works with care homes.


A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.


Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.


Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population.

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Corresponding author
Correspondence to: Steve Iliffe, Department of Primary Care & Population Health, University College London, Royal free Campus, Rowland Hill St., London NW3 PF, UK. Email:
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Alzheimer's Society. 2007: Home from home: quality of care for people with dementia living in care homes. London: Alzheimer's Society.
BDA. 2012: Dentistry in care home research – UK British Dental Association Research Unit. London: BDA.
Bowman, C. 2005: Health Service Support to Care Homes. Unpublished report commissioned by the British United Provident Association (BUPA), London.
Briggs, R., Robinson, S., Martin, F. and O’Neill, D. 2012: Standards of medical care for nursing home residents in Europe. European Geriatric Medicine 3, 365367.
British Geriatric Society (BGS). 2011: Quest for quality: Joint working party inquiry into the quality of health care provision for older people in care homes. London: British Geriatrics Society.
British Geriatric Society (BGS). 2013: BGS Commissioning Guidance: high quality health care for older care home residents. London: British Geriatrics Society. Retrieved 12 August 2014 from
Carter, C. 2011: Failing the frail: a chaotic approach to commissioning healthcare services for care homes. British Geriatrics Society. Retrieved 12 August 2014 from
Chikura, G. 2010: Care homes project. Unpublished report commissioned by Nottinghamshire County NHS, Nottinghamshire County.
CQC. 2012: Health care in care homes. A special review of the provision of health care to those in care homes London: Care Quality Commission. Retrieved 12 August 2014 from
Darton, R. 2011: Study of care home residents’ and relatives’ expectations and experiences. PSSRU, University of Kent, for the Registered Nursing Home Association. Retrieved 12 August 2014 from
Davies, S.l., Goodman, C., Bunn, F., Victor, C., Dickinson, A., Iliffe, S., Gage, H., Martin, W., Froggatt, K. 2011: A systematic review of integrated working between care homes and health care services. BMC Health Services Research 11, 320.
Donald, I.P., Gladman, J., Conroy, S., Vernon, M., Kendrick, E. and Burns, E. 2008: Care home medicine in the UK – in from the cold. Age and Ageing 37, 618620.
ECCA. 2008: Can we afford the doctor? GP retainers and care homes English Community Care Association London. Retrieved 12 August 2014 from
Gage, H., Dickinson, A., Victor, C., Williams, P., Cheynel, J., Davies, S.L., Iliffe, S., Froggatt, K., Martin, W. and Goodman, C. 2012: Integrated working between residential care homes and primary care: a survey of care homes in England. BMC Geriatrics 12, 71.
Gage, H., Goodman, C., Davies, S.L., Norton, C., Fader, M., Wells, M., Morris, J., Williams, P. 2010: Laxative use in care homes. Journal of Advanced Nursing 66, 12661272.
Gladman, J. 2010: Provision of medical care in UK care homes. Medical Crises in Older People discussion paper series. Issue 1 University of Nottingham. Retrieved 12 August 2014 from
Glendinning, C., Jacobs, S., Alborz, A., Hann, M. 2002: A survey of access to medical services in nursing and residential homes in England British Journal of General Practice 52, 545549.
Goodman, C. and Davies, S. 2011: Good practice outside care homes. In Milne, A. and Dening, T., editors, Mental health and care homes. Oxford University Press, 297312.
Goodman, C., Davies, S., Dickinson, A., Froggatt, K., Gage, H., Iliffe, S., Martin, W., Victor, C. 2013: A study to develop integrated working between primary health care services and care homes Health Service Delivery and Research Programme. Retrieved 12 August 2014 from
Goodman, C., Mathie, E.J., Cowe, M., Mendoza, A., Westwood, D., Munday, D., Wilson, P.M., Crang, C., Froggatt, K., Iliffe, S., Manthorpe, J., Gage, H. and Barclay, S. 2011: Talking about living and dying with the oldest old: public involvement in a study on end of life care in care homes. BMC Palliative Care 10, 20.
Goodman, C., Robb, N., Drennan, V. and Woolley, R. 2005: Partnership working by default: district nurses and care home staff providing care for older people Health and Social Care in the Community 13, 553562.
Goodman, C., Woolley, R. and Knight, D. 2003: District nurses’ experiences of providing care in residential homes: issues of context and demand. Journal of Clinical Nursing 12, 6776.
Gordon, A.l., Franklin, M., Bradshaw, L., Logan, P., Elliott, R. and Gladman, J.R. 2014: Health status of UK care home residents: a cohort study. Age and Ageing 43, 97103.
Hayes, N. and Martin, F. 2004: Supporting care homes: the older people's specialist nurse. British Journal of Nursing 13, 12501257.
Jacobs, S., Alborz, A., Glendinning, C. and Hann, M. 2001: Health services for homes. A survey of access to NHS services in nursing and residential homes for older people in England. NPCRDC Report, University of Manchester.
Joseph Rowntree Foundation. 2008: Providing nursing support within residential care homes. Joseph Rowntree Foundation. York, ISSN 0958-3084.
Lawrence, V. and Banerjee, S. 2010: Improving care in care homes: a qualitative evaluation of the Croydon Care Home Support Team. Aging and Mental Health 14, 414442.
Monaghan, N. and Morgan, M. 2010: Oral Health Policy and access to dentistry in care homes. Journal of Disability and Oral Health 11, 6168.
Morgan, M. and Monaghan, N. 2012: Oral health and dental care in residential and nursing homes in Wales 2010–2011. Retrieved 12 August 2014 from
Morris, J. 2008: Service Review of Barchester Care Homes. Unpublished report commissioned by Barchester Healthcare Ltd, London.
Purandare, N., Burns, A., Challis, D., Morris, J. 2004: Perceived mental health needs and adequacy of service provision to older people in care homes in the UK: a national survey. International Journal of Geriatric Psychiatry 19, 549553.
Quince, C. 2013: Low expectations: attitudes on choice, care and community for people with dementia in care homes. Alzheimer’s Society. Retrieved 12 August 2014 from
Robbins, I., Gordon, A., Dyas, J., Logan, P. and Gladman, J. 2013: Explaining the barriers to and tensions in delivering effective healthcare in UK care homes: a qualitative study. BMJ Open 3, 3(7): doi: 10.1136/bmjopen-2013-003178.
Sackley, C., Hoppitt, T., Cardoso, K., Levin, S. 2009: The availability and use of allied health care in care homes in the Midlands, UK. International Journal of Therapy and Rehabilitation 16, 218222.
Seymour, J.E., Kumar, A. and Froggatt, K. 2011: Do nursing homes for older people have the support they need to provide end of life care? A mixed methods enquiry in England. Palliative Medicine 25, 125138.
Steves, C.J., Schiff, R. and Martin, F.C. 2009: Geriatricians and care homes: perspectives from geriatric medicine departments and primary care trusts. Clinical Medicine 9, 528533.
Szczepura, A., Nelson, S. and Wild, D. 2008: In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost effectiveness. BMC Health Services Research 8, 269.
Szczepura, A., Wild, D. and Nelson, S. 2011: Medication administration errors for older people in long-term residential care. BMC Geriatrics 11, 82.
Thompsell, A. 2011: Support to Care Homes. In Dening and Milne, editors, Mental Health and Care Homes. 225236. Oxford University Press.
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
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