Some doctors are refusing to visit elderly care home residents, a BBC investigation has found.

Instead they are offering a diagnosis over the phone which care home managers say is unsatisfactory and dangerous.

In one case, care home records show a GP refused or reluctantly made a visit to a man suffering from pneumonia on three occasions.

The British Medical Association told the BBC it agreed the quality of care given to care homes could vary.

Debbie Dean told the BBC's Radio 5 live Investigates programme that her family struggled to get a GP to come out to see her 71-year-old father as he lay suffering from pneumonia in a care home in Stoke-on-Trent.

Cecil Dean was suffering from lung disease and mild dementia. There were problems with getting him on the right medication and setting his oxygen levels.
'Couldn't be bothered'

On Mr Dean's notes at the care home, seen by the BBC, staff recorded that his GP had on three occasions over a three-month period either refused to come out or had reluctantly made a visit.

In the hours before her father died in January 2010, Ms Dean says her brother had to insist that the GP come into the home to assess his condition.

"To me, the doctor couldn't be bothered to come out and see the patient - he would rather prescribe over the phone rather than actually come and see him," says Ms Dean.

"The doctor would eventually come out - but on the days he would refuse, he would just prescribe over the phone."

The GP, who has since retired, has refused to comment.

Martin Green, from the English Community Care Association, a group representing the owners of care homes, believes up to one third of residents could be missing out on the full range of GP services they are entitled to.

"There is really bad practice out there. We have got to get out of the habit of saying 'there's some good practice'," he told BBC Radio 5 live.

"There are islands of good practice in a sea of bad practice. If you are paid to do a job, you should be doing it.
"If we had better quality of care, then older people wouldn't get into crisis and end up in A&E."

Mr Green says care homes complain of not getting visits they have requested, adding: "They often don't get access to a lot of the support services around primary care, like physiotherapy and speech and language therapy, all which are extremely important for people who, for example, have strokes.

"It's quite clear that in some areas people who live in care homes are not getting the same services that the rest of us are getting who live in the community."

In some cases, homeowners pay for enhanced services from GPs, amounting to thousands of pounds a year.

But Mr Green says sometimes these "enhanced" services - such as out-of-hours cover - are entitlements that are provided by the NHS.

"Because there isn't much clarity of what we should expect there is a difficulty in specifying what the 'enhanced' service really means.

"Out-of-hours services are enhanced services, but if I'm sat at home and I ring my GP, there is a mechanism there that I can use - and that should apply to care homes.

"Our residents pay for these services through their national insurance," said Mr Green.

A report published by the Care Quality Commission (CQC) earlier this month found vulnerable people in care homes are struggling to get access to GPs and routine medicines.

The CQC looked at 81 care homes in England, chosen from areas previously flagged up as at risk of poor performance.

Only staff at 38% of homes reported they got regular visits from GPs, with one in 10 care homes saying they had to pay GPs to get them to visit residents.

A spokeswoman from the British Medical Association told the BBC they agreed the quality of care given to homes could vary.

The biggest issue is knowing how they are run. A facade can easily conceal how they are run and as I stated, often it's not until you get to see the inner workings that you realise what they're like and quite often the general public have no idea.

I would add to your list of criteria is turnover of staff. If there are lots of nurses passing through, is there any reason why they haven't decided to stay on? Why are they leaving? It often highlights problematic areas as most nurses are good and want to try the best for their patients.