Primary care for care home residents: Changes over time before and through the COVID-19 pandemic

Study type
Date of Approval
Study reference ID
Lay Summary

Most people who live in care homes are older adults. Many have several health problems, and need help with daily tasks. Family doctors (general practitioners) look after their day-to-day medical care, working with care home or community nurses. In England, there have been moves to improve healthcare for people in care homes. In this study, we will look at how care home residents use general practice services. We will look at service use at a time when changes were introduced, and during the COVID pandemic. To do this, we will analyse information from electronic healthcare records in primary care, using the CRPD Aurum research database. Findings from this work will tell us how use of primary care by residents has changed over time, and whether number of contacts with primary care staff, prescriptions or referrals to hospital (for example), differ according to the care home workload for each practice. Overall the research will help to understand whether primary care for care home residents seems to be improving, whether it is a good idea for practices to take on many residents, and how things have changed across the pandemic.

Technical Summary

General practice provides front line NHS care for around 400,000 care home residents in the UK. Good care has the potential to optimise health, wellbeing and use of hospital services, but it is difficult to deliver. There have been a number of initiatives in England to improve primary care for care home residents. The NHS England Vanguard funded innovation in services for care homes in five areas (2015-2018), and this led to an England-wide initiative (Enhanced Health in Care Homes) to introduce standardized primary healthcare processes between 2020-2024. The COVID-19 pandemic also heightened awareness of the importance of primary care to care homes, and is likely to have complicated the introduction of changes in ways of working.
The aim of this study is a) to describe selected aspects of primary care services over time in care homes, before and after the introduction of the Enhanced Health in Care Homes Framework, and in the context of the coronavirus pandemic, and b) to identify factors associated with higher levels of health service utilisation by care home residents.
Design: Analysis of primary care data from CPRD Aurum
Participants: Care home residents =>75years, registered with participating practices in CPRD Aurum 2017-2023.
Methods: Comparison of annual consultations, referrals and polypharmacy for residents in different practices, with practices classified by the number of registered patients who are care home residents. Multivariable regression models will investigate individual and practice level factors associated with higher rates of consultation rates and polypharmacy.
Output: This study will draw conclusions on variation in general practice utilization by care home residents, how this changed across the COVID-19 pandemic and introduction of standardized processes, and according to practice care home workload.

Health Outcomes to be Measured

All-cause hospitalisation; Admission to Accident and Emergency; Primary care contacts; Number of prescribed items.


Barbara Hanratty - Chief Investigator - Newcastle University
Barbara Hanratty - Corresponding Applicant - Newcastle University
David Sinclair - Collaborator - Newcastle University