Looking after elderly sick people is core work in general practice

Editor–A recent news article seems to condone the fact that “general practitioners in several areas of Britain have successfully negotiated extra payments for the medical care of residents in nursing homes that they do not consider part of their core work.” As a retired general practitioner and hospital practitioner in geriatric medicine and now (for the past eight years or so) a designated old age pensioner, I write to criticise this apparently growing practice among my former colleagues in general practice.

As you grow older you often need medical attention; this is acknowledged in the NHS by an extra payment to general practitioners. Such attention is best given, in the first place, by the elderly person's own general practice, where he or she has often been registered for many years and has built up a close rapport over this time. Should elderly people end up in a nursing home, for whatever reason, then they deserve the same medical attention (when required) from their general practitioner as they would get if they were in their own home.

To claim that “patients in nursing homes take up a disproportionately large amount of [general practice] time at the expense of the rest of the community,” as Dr Sadiq Ali is quoted as saying, is a gross overstatement. Even if it were partly true, how does claiming more money to look after these patients remedy the situation?

My advice to my colleagues who are at present in general practice is this: remember that you will be old one day and that you will not wish to be categorised as someone who is, as this proposed claim implies, an extra burden on your doctor's practice. Bear in mind, too, that quite a number of elderly people already feel that they are a trouble to their families.

Looking after elderly sick people, wherever they happen to live, is both satisfying and an honour. General practitioners should certainly include such care in their core work. Maybe those who consider it to be “non-core” are in the wrong vocation.