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Registration Number: {{org_field_registration_no}}

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Requesting Medical Support: GP, Paramedic, and Specialist Services Policy

1. Purpose

The purpose of this policy is to ensure that all residents at {{org_field_name}} receive timely, appropriate, and effective medical support when required. This policy sets out how our care home manages requests for General Practitioner (GP) services, paramedic attendance, and specialist medical support, ensuring the best possible health outcomes for residents. It outlines the roles and responsibilities of staff, the process for accessing medical care, and how we maintain clear communication with healthcare professionals, residents, and families. This policy aligns with Care Inspectorate Wales (CIW) regulations and the Health and Social Care (Quality and Engagement) (Wales) Act 2020 to ensure high-quality healthcare support for all residents.

2. Scope

This policy applies to all residents, ensuring they receive appropriate medical care when needed. It applies to all care and nursing staff, who are responsible for monitoring residents’ health and escalating concerns. It applies to external healthcare professionals, including GPs, paramedics, hospital teams, and specialist clinicians. It applies to families and next of kin, ensuring they are involved in key medical decisions where appropriate.

3. Related Policies

This policy aligns with Safe Care and Treatment Policy (CHW11)​, Medication Management and Administration Policy (CHW21)​, End of Life and Palliative Care Policy (CHW38)​, Infection Prevention and Control Policy (CHW17)​, Mental Capacity and Deprivation of Liberty Safeguards Policy (CHW39)​.

4. Identifying When Medical Support is Needed

Care staff play a critical role in monitoring residents’ health and identifying when medical support is required. Staff must be trained to recognise signs that indicate the need for GP consultation, paramedic attendance, or specialist intervention. Signs that medical support may be needed include sudden changes in physical health, signs of infection or fever, persistent pain, breathing difficulties, confusion or sudden cognitive decline, refusal to eat or drink, falls or injuries, worsening of chronic conditions, end-of-life care needs. Staff must record and report any concerns promptly and escalate medical support without delay when necessary.

5. Requesting GP Services

Residents must be supported to access GP services whenever this is necessary to protect, promote and maintain their health and well-being. In accordance with Regulation 33 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, {{org_field_name}} must have arrangements in place to support each resident to be registered with a General Practitioner and to access treatment, advice and other healthcare services as necessary.

Where a resident moves into the care home and requires GP registration, staff must assist the resident to register with a GP of their choice, subject to the normal NHS arrangements for GP registration and practice boundaries. The care home must not require a resident to transfer to a particular GP practice solely because that practice usually provides services to the care home.

Residents must be supported to access GP services for both routine and urgent medical concerns. Medical advice and professional help must be sought in a timely manner where this is necessary.

5.1. Routine GP Appointments

Routine GP appointments may be requested for ongoing medical conditions, medication reviews, planned vaccinations and other non-urgent health concerns.

Care staff must:

• identify and accurately record the resident’s symptoms, concerns or reason for referral;
• support the resident to communicate their views, wishes and preferences;
• contact the resident’s GP practice using the appropriate referral or appointment process;
• provide the GP with relevant and accurate information necessary for the consultation;
• support the resident to attend or participate in the consultation where required;
• record the consultation, advice received, treatment prescribed and any actions or follow-up required; and
• update the resident’s personal plan, risk assessments or other relevant care documentation where the consultation results in a change to the resident’s assessed needs, treatment or support.

Information about the appointment or its outcome must only be disclosed to relatives, friends or other persons in accordance with the resident’s wishes, confidentiality requirements, applicable data protection requirements and, where relevant, lawful decision-making arrangements.

5.2. Urgent GP Consultations

An urgent GP consultation must be requested where a resident develops new, sudden or worsening symptoms which require prompt clinical assessment but which do not amount to an immediately life-threatening emergency.

This may include:

• a significant deterioration in an existing health condition;
• signs or symptoms of infection;
• new or unexplained pain;
• an acute change in cognition, behaviour or level of consciousness which is not immediately life-threatening;
• significant deterioration in mobility;
• reduced oral intake or signs of dehydration;
• concerns following a fall or injury that do not require an immediate 999 response; or
• any other deterioration where staff are concerned that prompt clinical assessment is required.

Staff must not delay seeking medical advice while waiting for a routine visit where the resident’s condition is deteriorating.

Where the GP practice is closed or appropriate urgent primary-care advice cannot be obtained from the resident’s GP, staff must use the appropriate NHS urgent-care pathway. NHS 111 Wales may be contacted for urgent medical advice and access to urgent primary care outside normal GP arrangements. Where the resident’s condition becomes life-threatening or an emergency develops, staff must call 999 immediately.

All advice received and action taken must be recorded in the resident’s records and communicated to relevant staff.

6. Requesting Paramedic Support (999 Calls)

Paramedic services must be called in any medical emergency where a resident’s condition requires urgent medical intervention or hospital admission. A 999 call should be made immediately for: Severe breathing difficulties or suspected respiratory failure, unresponsive or unconscious residents, suspected stroke (FAST symptoms: Face drooping, Arm weakness, Speech difficulty), chest pain or suspected heart attack, suspected fractures or severe injuries from falls, suspected sepsis (slurred speech, extreme shivering, no urine output, breathlessness, skin discolouration), choking or severe allergic reactions, sudden severe pain with unknown cause. When calling 999, staff must clearly state: “This is an emergency call from {{org_field_name}} care home. We have a resident experiencing [describe symptoms]. They are [age] years old, have [list any relevant medical conditions], and their current observations are [heart rate, breathing rate, blood pressure, temperature, oxygen saturation if available].”

While waiting for paramedics, staff must stay with the resident, ensure they are as comfortable as possible, and continue monitoring their vital signs.

Where a resident is transferred to hospital or another healthcare setting, staff must ensure that the receiving healthcare team is provided promptly with the information necessary for safe and effective continuity of care. This must include, as relevant, the resident’s identity, presenting concern, current medicines, known allergies, significant diagnoses and medical history, current observations, communication needs, mobility and support needs, infection risks, relevant mental-capacity information, any applicable advance decision or treatment-escalation documentation, and details of any person with lawful health and welfare decision-making authority. Medicines must accompany the resident only where required under the home’s medicines-transfer procedures. Information shared must be limited to what is necessary and handled securely.

7. Requesting Specialist Medical Services

Some residents require ongoing specialist care, which must be arranged proactively by the care team.

7.1. Referrals to Specialist Services

GPs will typically refer residents to specialist medical teams, including geriatrics, cardiology, neurology, respiratory specialists, mental health services, or palliative care teams. Staff should support this process by ensuring appointments are attended, communicating with specialists, and documenting any treatment plans provided.

7.2. Community Nursing and Therapy Services

Residents may require community nursing input for wound care, catheter management, diabetes monitoring, or palliative care support. Care staff must liaise with district nursing teams to ensure timely interventions. Specialist therapies such as physiotherapy, occupational therapy, and speech and language therapy (SALT) should be arranged for residents requiring mobility rehabilitation, swallowing assessments, or communication support.

7.3. Mental Health and Dementia Support

Residents experiencing mental health deterioration, distress, or behavioural challenges may need referral to Community Mental Health Teams (CMHTs) or dementia specialists. Staff should ensure that mental health referrals are made via the resident’s GP or directly through local mental health support services.

8. Communication, Confidentiality, Mental Capacity and Consent

Residents must be involved in decisions about their healthcare and medical treatment to the greatest extent possible. Staff must respect each resident’s privacy, dignity, autonomy, confidentiality, communication needs, wishes and preferences when requesting or supporting access to medical services.

8.1. Informing Relatives, Representatives and Other Persons

Information about a resident’s health, GP consultation, ambulance attendance, hospital transfer, specialist referral, diagnosis or treatment must only be shared where there is a lawful basis for doing so.

Where the resident has capacity to make the relevant decision, staff must follow the resident’s wishes about who may receive information about their healthcare. A relative, friend or person identified as “next of kin” does not acquire an automatic legal right to receive confidential medical information merely because they are the resident’s next of kin.

Where appropriate, staff must establish and record:

• whom the resident wishes to be informed about changes in their health;
• what information the resident consents to being shared;
• any communication preferences or restrictions identified by the resident; and
• whether any person has lawful authority to act on the resident’s behalf.

Information may be provided to a person who has lawful authority to act for the resident in relation to the matter concerned, including, where applicable, an attorney acting under a valid and applicable Lasting Power of Attorney for Health and Welfare or a deputy appointed by the Court of Protection with relevant authority.

Where information has been shared, staff must record:

• the person contacted;
• their relationship or legal authority where relevant;
• the date and time;
• the information provided; and
• any response, decision or action arising from the communication.

Nothing in this section prevents staff from sharing necessary information with healthcare professionals or other organisations where there is another lawful basis or legal duty to do so, including where this is necessary to protect the resident or another person from serious harm or to comply with safeguarding or regulatory requirements.

8.2. Consent and Mental Capacity

A resident who has capacity to make a particular healthcare decision has the right to make that decision, including the right to consent to or refuse examination, treatment, referral or hospital attendance, subject to the law.

Mental capacity must be considered in accordance with the Mental Capacity Act 2005. Capacity is decision-specific and time-specific. A person must not be treated as lacking capacity merely because of their age, diagnosis, disability, appearance, behaviour or because they make a decision that others consider unwise.

Where there is reason to doubt a resident’s capacity to make a particular healthcare decision, an appropriate assessment of capacity must be undertaken in relation to that specific decision.

Where the resident lacks capacity to make the relevant decision:

• staff and healthcare professionals must establish whether there is a valid and applicable advance decision to refuse treatment;
• staff must establish whether there is an attorney acting under a valid Lasting Power of Attorney for Health and Welfare with authority to make the decision concerned;
• staff must establish whether a Court of Protection deputy or court order gives another person authority in relation to the decision;
• where no person has lawful authority to make the decision, any act or decision made for or on behalf of the resident must be made in accordance with the Mental Capacity Act 2005 and in the resident’s best interests;
• the resident must be involved in the decision as far as reasonably practicable;
• the person’s past and present wishes and feelings, beliefs and values and other factors they would be likely to consider must be taken into account;
• appropriate consultation must take place with relevant family members, friends, carers or others interested in the resident’s welfare where required by the Mental Capacity Act 2005; and
• an Independent Mental Capacity Advocate must be instructed where the statutory requirements for IMCA involvement apply.

Being a relative or being recorded as next of kin does not, by itself, give a person authority to consent to or refuse medical treatment on behalf of a resident who lacks capacity.

Any assessment of capacity, best-interests decision, consultation, advance decision, Lasting Power of Attorney, deputyship or other lawful authority relevant to the resident’s healthcare must be clearly documented and made available to staff and healthcare professionals as appropriate.

Where urgent treatment is required and the resident lacks capacity to consent, necessary treatment may be provided by the appropriate healthcare professional in accordance with the Mental Capacity Act 2005 and other applicable law. Staff must not delay obtaining emergency medical assistance while attempting to obtain consent from a relative who has no lawful decision-making authority.

9. Record-Keeping, Follow-Up and Regulatory Notifications

9.1. Medical and Healthcare Records

All requests for, and contacts with, GPs, ambulance services, NHS 111 Wales, hospital services, community healthcare professionals and specialist services must be recorded accurately and without unnecessary delay in the resident’s records.

The record must include, where applicable:

• the date and time the concern was identified;
• the resident’s presenting signs, symptoms or change in condition;
• relevant observations and assessments undertaken by staff;
• the name or role of the member of staff identifying or escalating the concern;
• the healthcare service or healthcare professional contacted;
• the date and time contact was made;
• relevant information provided to the healthcare professional;
• advice, instructions or clinical decisions received;
• any treatment, medicine or intervention prescribed, commenced, changed or discontinued;
• whether an ambulance was requested or attended;
• whether the resident was transferred to hospital or another healthcare setting;
• the resident’s consent or, where relevant, details of capacity and lawful decision-making arrangements;
• any communication with a representative, relative, service commissioner or other relevant person;
• follow-up actions required;
• the person responsible for completing those actions;
• the outcome of the consultation, referral or treatment, where known; and
• any subsequent change in the resident’s condition.

Records relating to professional consultations, resulting actions and relevant correspondence from GPs, hospitals and other health or allied healthcare professionals must be retained as part of the resident’s health and care record.

Where medical advice, assessment, diagnosis or treatment identifies a change in the resident’s care and support needs, risks or personal outcomes, the resident’s provider assessment, personal plan, risk assessments and other relevant records must be reviewed and revised as necessary.

Staff receiving verbal instructions or advice from a healthcare professional must record the advice clearly, including the identity or role of the professional providing it, and must ensure that any required actions are communicated to relevant staff.

Records must be legible, accurate, contemporaneous, attributable to the person making the entry, stored securely and made available to the service regulator where lawfully required.

9.2. CIW Notifications Following Medical Events

The Registered Manager, service provider and Responsible Individual must ensure that medical incidents are considered promptly against the notification requirements of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

The service provider must notify Care Inspectorate Wales, without delay and in the manner and form required by CIW, where an event falls within the statutory notification requirements, including, where applicable:

• a serious accident, injury or illness affecting a resident;
• the death of a resident where accommodation is provided;
• an outbreak of an infectious disease;
• an incident which is reported to the police;
• any event which prevents, or could prevent, the service provider from continuing to provide the service safely; or
• any other event for which notification is required under the Regulations.

The fact that an ambulance has attended or that a resident has been transferred to hospital does not, by itself, determine whether a CIW notification is required. The circumstances and seriousness of the event must be considered against the applicable statutory notification criteria.

Where a notification is required:

• the appropriate manager or authorised person must ensure that the notification is submitted without delay;
• the notification must contain the required details of the event;
• the notification must be submitted through the method required by CIW, including CIW Online where applicable;
• a copy or record of the notification must be retained;
• the resident’s records and relevant incident records must clearly cross-reference the notification; and
• any subsequent information or outcome required by CIW must be provided and recorded.

The Responsible Individual must ensure that effective systems are in place to identify, record, monitor and submit matters for which notification to CIW is required.

10. Training and Staff Responsibilities

All staff receive training on recognising medical emergencies, calling for help, and following CIW-compliant procedures. Staff responsible for making medical requests must be trained in effective communication with GPs, paramedics, and specialist services. Senior care staff and managers oversee medical request procedures and ensure compliance with CIW regulations.

11. Policy Review

This policy will be reviewed annually or sooner if: CIW regulations change, new best practice guidelines are introduced, or staff or resident feedback suggests improvements.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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