143 Barriers and Facilitators of General Practice in the Care Home Setting- A Qualitative Study to Inform Training of GPS

Abstract Introduction Care home (CH) residents receive varying quality and availability of healthcare. GPs are tasked with the responsibility of providing effective care to this growing demographic. The study aimed to gain an insight into the experiences of GPs carrying out CH work, in order to produce training recommendations. Method Two trainees, one trainer and twelve senior GPs were recruited informally through professional networks. Each completed a semi-structured interview about their work within CHs. Transcriptions were made and then analysed using thematic analysis. Results The two trainee participants had different experiences of CH work, but neither had received any specific training. The trainer GP acknowledged that multiple existing trainee competencies were relevant to CHs, but that inconsistencies in CH exposure were present and that specific training would be beneficial. The senior GP participants did not recall having received CH-specific training. Many factors contributed to the delivery of care within the CHs and made it distinct from the work within the GP surgery. Participants reported a variety of approaches to care, these related to different multidisciplinary teams, the involvement of CH staff, and the complex nature of the care of residents. Advance care planning was a beneficial approach used by some of the GPs that required particular attention and skills. Conclusion A tension was present between the care GPs wanted to provide and the complexities that inhibited them from doing so. The challenges relate to the need for multidisciplinary care teams to address complex needs of individual residents, and an acknowledgement of the importance of the relationship with the CH staff in supporting continuity of care. Overall, the complex nature of CH work, and the current inconsistencies in trainee’s exposure, justify the need for a new approach to provide all trainee GPs with experience of working within the CH setting.