Doctor’s charges to care homes: why are we still tolerating – or colluding with – this?


Posted on June 15th, by geoff in CT blog. 2 comments

By guest blogger JOHN BURTON

author and independent consultant

Following up Leon Smith’s excellent blog (Government should act on doctors’ charges to care homes) and two strong responses from Debbie Sorkin and Martin Green, I offer the following story:

In 1982, as a newly appointed “officer in charge” of a 120-place care home in Lambeth, I had to confront the problem of a drunken, neglectful and corrupt “visiting medical officer” who was paid a handsome retainer by the council. All residents were compelled to have him as their GP. His removal was one of the keys to changing the home but initially the local health bosses rallied behind him.

As with other major barriers to change, I had to force my bosses in the council to confront the issue with their NHS counterparts. The first defensive move was to attempt to shift the blame for the appalling healthcare in the home (widespread incontinence and UTIs, terrible pressure sores, chaotic medication) on the manager (me) and the staff, and to have me removed. But in the long run the health review served only to substantiate my complaints against the doctor. He resigned. Residents were encouraged to choose their own GPs. Payments for a visiting medical officer were stopped. A district nurse was allocated to the home and led the transformation of health care, teaching care staff, and setting up healthy living events for the local community – a model of health and social care integration that spread to other homes in the borough.

So, why are we still talking about it? Every citizen living in the UK has the right to register with a local GP who can turn them down only if their list is full. A GP may not refuse patients on the grounds of age. We are still talking about it because social care is complicit in the very problems it exists to confront. Managers are expected to comply, not defy. If you say all the right things and accept your lowly place in the system, you’ll be OK.

Anyone signing The Social Care Commitment promises to “always promote and uphold the privacy dignity, rights, health and wellbeing of people who need care and support.” Sounds good, doesn’t it? But we still allow GPs to refuse care home residents as patients unless they are paid extra to do so.

Oh, and one last thing, care homes and GPs share the same regulator, don’t they?

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.




2 responses to “Doctor’s charges to care homes: why are we still tolerating – or colluding with – this?”

  1. Martin Green says:

    That is an excellent point about both care homes and GPs having the same regulator, John.

    We have been encouraging providers and residents to feed into CQC’s inspections of GP practices by telling inspectors about the access to primary care that they receive in the services in which they live.

    We agree that this is a huge issue for providers and one that Care England is taking very seriously.

  2. Bob Ferguson says:

    Two things: first, not all managers – or owners, for that matter – are cut from John Burton’s heroic cloth. Second, isn’t the issue really a matter of contract rather than regulation? Which, I imagine, means taking it up in the first instance with the local CCG – and good luck with that!


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