A TOP GP says it "will be up to us as a country to reflect" on how we provide social care to the elderly in future, as he said the Covid crisis has shone a light on the "difficult situation" faced by care homes.

Dr Andrew Buist, chair of BMA Scotland's GP committee, also said that doctors who had contacted frail patients at the beginning of the outbreak to ask if they wished to be resuscitated if they suffered a cardiac arrest had "felt they were doing the right thing".

Figures last week revealed that 1,623 residents have died from Covid in care homes in Scotland since mid-March, while the total number of deaths from all causes - 4,504 - is twice as high as normal for the time of year.

"I think the care home situation is really interesting, and that is going to play out quite significantly over the next year," said Dr Buist.

"It's an area of our health and social care system which is essential but is outwith the NHS, and has been since the 1980s when there was a political decision to close NHS long-stay units because they could see what was going to happen to the population in terms of the number of people over 85."

Around two thirds of care homes in Scotland are privately-owned and there has been criticism that some major care providers have used tax havens to funnel profits offshore, thereby depriving the UK of funds which could be invested in social care.

The latest crisis has led to calls from some trade unions and politicians for care homes to be nationalised.

Dr Buist said: "Care homes are essential but they are poorly resourced compared to the NHS, the nurses are stretched, the care staff have worse terms and conditions than in the NHS, training is limited, access to equipment, PPE, dieticians and physios - it's all less good.

"And the medical care was given to general practice to do, with precious little time to do it, so the service is quite stretched.

"Then on top of that the funding is means-tested rather than necessarily being provided by the state.

"I think this Covid situation has highlighted the difficult situation care homes are in, and it will be up to us as a country to reflect and decide how much are we willing to change there?"

Dr Buist said there were advantages for patient care where a care home's residents were all looked after by the same GP practice, but that this was more likely to happen in rural rather than urban areas.

He added that a good relationship between GP practices and care homes could also play an important role in anticipatory care for residents approaching the end of their lives.

However, he said some recent discussions around DNACPR [do not attempt cardio-pulmonary resuscitation] had been mishandled.

It follows reports of some chronically ill patients or elderly people with dementia receiving phonecalls or letters out of the blue from GP practices inviting them to consent to do-not-resuscitate orders.

"They were taken on by GPs who felt that they were doing the right thing in the early part of April and it landed badly, as you might expect," said Dr Buist.

"I very much hope that that is not happening now.

"Quite early on in Covid there was a big drive to do anticipatory care planning and that's a good thing because it is a useful thing to have these conversations, particularly with elderly patients.

"A lot of it goes along the lines of 'how would you like to be cared for, what wouldn't you like, what's important to you?'

"But on the question of the DNACPR, we've changed our guidance to say that it's only a discussion to be had if the patient asks about it."

Dr Buist added that he was hopeful the Covid crisis could be seized on as an opportunity to reform general practice for the better, including making more use of phone and video consultations, and scrapping the need for every prescription to be signed by hand.

He said: "Some days I've counted more than 150 pieces of paper, signed by hand - and now of course all those bits of paper could be a source of infection. We have electronic means of doing things.

"I've spoken to the Government about this and I think they really do want to deliver it but there's all sorts of technical and some legal issues that are slowing it down.

"But England is now ahead of us on this and we are wasting clinicians' time."

Dr Buist added that the NHS should also build on the use of community treatment centres which have been taking blood samples from patients during the pandemic.

"Sometimes when you go to a hospital clinic or GP surgery, all you need is a conversation - maybe a decision about some tests that need doing.

"If we have these community treatment centres it means that not just primary but secondary care can make use of them, so that the patients can get their tests done before they see the specialist or before they come back to the GP.

"It should make it a better service."