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This guide has been put together to explain the distinction and to assist care home managers to know how best to contribute to the planning and provision of healthcare to residents.

Q1. How can a person who lives in a care home consult a GP?

A. Assuming that the residents of care homes, both residential and nursing, are ordinarily resident in the UK, then each individual is entitled to register with a GP or a doctor who is primarily responsible for the performance of personal medical services under a scheme for free NHS primary care. A person is 'ordinarily resident' for this purpose if lawfully living in the UK for a settled purpose for at least 6 months.

In addition, the Primary Care Trust (PCT) under which area the individual is based, is under a duty to assist those individuals who are entitled to and wish to obtain free NHS treatment.

Q2. The local practice says their list is full. How do we get our residents registered with a GP in these cases?

A. All UK residents are entitled to be treated by a doctor, although it may not be possible for patients to register with the GP of their choice. PCTs have powers to assign patients to a doctor if they have difficulty in finding one. It is important to tell your PCT if care home residents are having difficulty finding a GP. This will help the PCT plan for the provision of health care for all the people in its area.

Q3. We approached the nearest GP practice to ask for our residents to be registered and we were told we would have to pay a "retainer"? Is this right?

A. All residents of care homes can expect the full range of personal medical services and the same rights of access to primary care as any other patient group. And, as for everyone else, this service is free at the point of delivery. GPs should not, for example, charge residents of care homes for flu immunisation jabs because immunisation of people with asthma, diabetes and all people over the age of 65 is provided free of charge by the NHS.

Q4. Are there any instances where a GP can charge a fee for providing services to a care home?

A. A GP may enter into arrangements to provide professional services to any body or institution, including care homes. For example, it is not unusual for a care home to contract for the services of a doctor for services that the NHS does not normally need to provide to patients on an individual basis.

Examples of services which are not considered to be those which GPs offer as part of their NHS contract are the safe management and control of medicines, occupational health of the staff of the home, management of patients with problems of mobility or on infection control. These are different from individual, direct patient services, for which GPs should not be charging their registered patients.

It should be made clear to residents which services are provided under the GP's NHS contract and which are additional and might need to be paid for privately.

Q5. Older people take up more of a doctors' time and often require costly treatment. Aren't they at greater risk of being removed from doctors' lists as a result?

A. GPs have the right to remove any patient from their lists, just as any patient has the right to leave the list. However, removal should only be considered as a last resort, when the doctor/patient relationship has irretrievably broken down. The General Medical Council considers it unacceptable for a doctor to remove a patient solely on the basis of age.

Q6. Are there other ways in which GPs can provide healthcare to residents of care homes? For example, I've heard of Personal Medical Services schemes.

A. Patients still need to be registered with a GP, even if that GP is a member of a PMS scheme. GPs in PMS schemes provide the same services free at the point of delivery as GMS doctors. The PMS core contract provides a framework which ensures the continuation of services to patients, but is built upon locally to reflect local needs and is therefore more flexible and sensitive to the needs of the particular population those GPs serve.

GPs who work under the GMS contract can also receive incentives from the , Primary Care Trust to provide specially tailored health care to people in residential care homes. These are called Local Development Schemes and reflect the additional effort needed to care for people who may have special needs.

Q7. How can the managers of care homes influence the provision of health care to their residents?

A. PCTs are responsible for planning, commissioning and providing local health services. Care home managers should develop relationships with PCTs and become advocates for their residents. In this way they will have the opportunity to voice concerns and help to ensure that your residents get good access to health care.

PCTs are responsible for commissioning (hospital and community health) services for persons registered with GPs associated with their PCT, and those persons usually resident within their area. PCTs should feel free to commission care from wherever they can obtain the best services for patients, this includes the private and voluntary sectors among others (for further information, refer to HSC 2002/007 issued in April 2002). Commissioning decisions should be judged against the twin tests of high clinical standards and value for money. The StHA will manage the performance of every PCT to ensurethat it secures and delivers these services effectively.

Q8. Where can I get further help?

A. If the PCT is unable to help, your Strategic Health Authority can provide further advice and guidance.

Finally, it is worth noting that the BMA's own guidance to GPs on charges to patients is as follows:

"GPs contemplating making any charge to their NHS patients must ensure they comply with the strict requirements of the terms of service and that they act in accordance with the ethical duty not to use, or appear to use, their position of trust to influence patients to follow a particular course of action which may offer the doctor some advantage, financial or otherwise.

GPs must bear in mind that their action, in making a charge, could be alleged to involve accepting remuneration for treatment, which might be a breach of the terms of service, or breach of the ethical duty not to abuse their position of trust. The consequences could be a complaint to the FHSA, with a possible finding of a breach of the terms of service, possibly a complaint to the GMC's professional conduct committee or, ultimately, criminal proceedings."