"She'll need to register with our surgery"
Your mother moved into the home three weeks ago. You ring her old GP practice — the one she has been with since 1987, where they know she cannot tolerate one particular blood-pressure tablet — and the receptionist says she has been removed from the list. The home, meanwhile, has already registered her with a practice you have never heard of.
Nobody explained this on moving-in day, and it is one of the few things that changes immediately. It is also more within your control than it looks, provided you understand what actually drives it.
Why the practice changes
GP practices have a defined catchment area. If the care home falls outside your mother's old practice boundary, that practice is not obliged to keep her, and in practice will not: registration follows where the patient lives, and she now lives at the home.
There is a route to stay registered with a practice outside its boundary — out-of-area registration. But there is a catch that decides the matter for most care home residents: out-of-area registration comes without home visits. A resident who cannot get to a surgery twelve miles away, registered with a practice that is not obliged to come to her, has a GP on paper and no GP in the building. For a frail person in a care home that is worse than a new name on the list.
What the home cannot do is register her without anybody being asked. Registration is the resident's decision, or the decision of whoever holds a health and welfare lasting power of attorney if she can no longer make it herself. If it has already happened, it is reversible — but before you reverse it, read the next section, because the practice attached to the home may be giving her more than the old one could.
What a care home resident is supposed to get
Under the Enhanced Health in Care Homes arrangements, every care home in England is aligned to a single primary care network, and that network is contracted to deliver a defined package rather than reactive visits. In practice that should mean:
- a named clinical lead for the home;
- a weekly home round — a scheduled clinical visit to the home, not a call-out when someone deteriorates;
- a personalised care and support plan developed with the resident and family within days of moving in, and again after any hospital discharge;
- a structured medication review, which for a resident on ten or twelve medicines is the single most valuable thing on this list;
- agreed routes into community nursing, falls services, dietetics, speech and language therapy and out-of-hours care.
This is worth knowing because it converts a vague complaint — "nobody ever sees her" — into a specific question: when was the last home round, and was my mother seen on it? The home keeps records of those visits. Ask.
Everyone else who should be coming
The GP is not the whole of it, and the services families most often miss are the ones nobody offers unprompted.
Dentistry. A resident who cannot get to a high-street dentist can be seen by community dental services, in the home. Poor mouth care in dementia is one of the commonest silent causes of pain, refusing food and weight loss — and one of the few that can be fixed quickly. Ask when your mother's mouth was last looked at by a dentist rather than by a care assistant.
Eyes and ears. Domiciliary sight tests are available on the NHS for people who cannot leave home unaccompanied. Hearing aid batteries and re-tubing are routine but only happen if someone chases them. A resident who has stopped joining in downstairs is sometimes not withdrawn: she simply cannot hear.
Continence and tissue viability. Both are community nursing services with their own assessment routes. "The home deals with that" is not a complete answer.
Nights, weekends, and the form that matters most
Be clear about this, because assuming otherwise costs families dearly: there is no doctor in a care home overnight. There are care staff, sometimes a nurse if it is a nursing home, a protocol and a telephone. Out of hours the route is NHS 111, and 999 for an emergency.
So the useful question is not whether a doctor is there at night. It is who decides, at three in the morning, whether to call an ambulance — and on what written basis. That basis has a name: a ReSPECT form, or an equivalent treatment escalation plan, recording what should and should not happen in an emergency, including whether attempted resuscitation is appropriate and whether admission to hospital is what your mother would have wanted.
Two things families get wrong here. First, a decision not to attempt resuscitation is a clinical decision, but it must be discussed with your mother, or with you if she lacks capacity — a form completed without any conversation is not acceptable, and you can say so. Second, a ReSPECT form or advance decision kept in a drawer at your house does nothing. It has to be in her care records, in the home.
Six questions to ask
- Which practice is she registered with, and when was that done? Ask to see the confirmation, not a verbal answer.
- Which primary care network is the home aligned to, and when is the weekly round? A named day is a good sign; vagueness is not.
- Has she had a structured medication review since moving in? If not, request one and put the request in writing.
- Is there a ReSPECT form or treatment escalation plan, and who was involved in agreeing it?
- How will I be told about a change in her treatment? Fix the route — a call, an email, a note at a review meeting. Without a route, you find out by accident.
- Who has authority to consent if she cannot? If there is a health and welfare lasting power of attorney, the home needs a copy on file. If there is not, decisions are made in her best interests under the Mental Capacity Act, and you should know who is making them.
If the answers do not come
Put it in writing, with one clear question and a date. If it concerns the medical care, start with the practice manager at the GP surgery, then the NHS complaints route through the integrated care board, with PALS available to help you navigate it. If it concerns the home — staff not passing on concerns, reviews that never happen — the manager first, then the Care Quality Commission, which cannot resolve your individual case but does act on patterns and does read what families send.
Keep copies. Not because it will end up in a tribunal, because it almost never does, but because in a home that changes manager twice a year, the family with the folder is the only one with a memory.
Where to start
If you are still choosing a home, "which practice covers you, and what day is the round?" tells you more in two minutes than an hour-long tour. If your mother has already moved in and you have only now discovered her GP changed, nothing is lost: these six questions work in writing, and they are almost always answered.
If you would rather not do it alone, we can. For £69 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical or legal advice on your own situation. NHS arrangements differ across England, Scotland, Wales and Northern Ireland, and between areas: check with the home and the GP practice. Curalune does not allocate beds and does not guarantee availability.
