Who Does What: GP, District Nurse, Social Worker and the Rest of the Cast

Every professional around a person being cared for at home owns exactly one kind of decision, and the fastest way to lose a fortnight is to put a question to the person who cannot answer it. Skin goes to a nurse. Medicines go to a GP or a pharmacist. Assessments, budgets and care plans go to a social worker. Equipment goes to an occupational therapist. Once you can name the owner of a decision you stop making the two commonest calls in family caring, which are the wrong call and the vague one.

I lost about three weeks in 2023 asking a GP receptionist about a reddened patch on my mother’s heel, being told the doctor would ring back, and then not knowing what to do when he did and said it sounded like a district nurse job. Nobody had ever explained to me that a community nursing service existed as a thing you could be referred to, still less that in many areas you can ask for a referral yourself. The care itself was not complicated. The map was.

This article sits under caring for a parent at home. Print the table at the bottom, or copy the numbers into the front of the care file.

The rule that saves the most time

Ask yourself one question before you dial: which decision am I asking somebody to make?

Not “who should I tell about this”, which is how most carers frame it, and which produces a call to whoever answered last time. Decisions have owners, and the owner is usually obvious once you name the decision:

• A decision about a diagnosis, a medicine or a referral belongs to a doctor.
• A decision about skin, a wound, a catheter or a repositioning plan belongs to a nurse.
• A decision about what care is provided, who pays, and what the plan says belongs to a social worker or an equivalent assessor.
• A decision about equipment or an adaptation belongs to an occupational therapist.
• A decision about how somebody moves, walks or transfers belongs to a physiotherapist.
• A decision about the whole medicines list belongs to a pharmacist or a GP through a structured medication review.

Then say the decision out loud when you ring: “I am asking for a district nurse assessment of a heel”, not “I am ringing about my mother’s foot.”

The GP or family doctor: diagnosis, prescribing and the gateway

The GP owns diagnosis, prescribing, and the referral that unlocks most of the rest of the cast. That third one is why the GP remains the default first call even for things they will not deal with themselves.

What to bring them: change, in dates, against a baseline. “She was doing the crossword on the 4th and could not follow a sentence on the 6th” is a clinical observation. “She has not been herself” is not. New confusion, especially confusion that comes and goes through the day, belongs to them the same day: delirium usually develops over 1 to 2 days, and NICE states that it can be prevented and treated if dealt with urgently¹. Be equally alert to the quiet version, because NICE tells clinicians to be “particularly vigilant for changes that may indicate hypoactive delirium, which are often missed, such as withdrawal, slow responses, reduced mobility and movement, worsened concentration and reduced appetite”¹.

The other thing to ask a GP for is a structured medication review, and it usually has to be requested. NICE guideline NG5 recommends considering one for people taking multiple medicines, people with long-term conditions and older people², and it says the review should take into account the person’s and carers’ views and concerns, all prescribed, over-the-counter and complementary medicines and what each is for, safety, effectiveness and appropriateness, risk factors for adverse drug reactions, and the monitoring needed². No page on this site gives a dose or tells you to give or withhold anything, and that is deliberate: that decision belongs to the prescriber and the pharmacist, who can see the whole list. Managing someone else’s medication covers the round and how to ask for the review.

The district or community nurse: skin, wounds and the plan for the body

The district or community nurse owns everything to do with skin integrity, wounds, dressings, catheters, and how often somebody is repositioned. If a question involves a break in the skin or a tube, this is the right call, and going to a doctor first usually just adds a step.

The most important thing they can give you is a written repositioning plan for this person on this mattress, and the reason is that the published guidance genuinely disagrees. NICE CG179 sets minimum frequencies of at least every 6 hours for adults at risk and at least every 4 hours for adults at high risk³. The fourth edition of the international guideline suggests either two hourly or three hourly intervals for most people at risk who are on an appropriate pressure redistribution full body support surface, and separately suggests not routinely extending intervals to four, five or six hourly, both as conditional recommendations on very low certainty evidence⁴. Do not resolve that yourself from a web page. Ask the nurse for a plan in the care record, and ask when it will be reviewed.

Two other things that belong to them. The blanching test: NICE says finger palpation or diascopy should be used to determine whether redness or discolouration is blanchable, and redness that does not go pale means damage has already happened³. And a piece of household folklore they will tell you to stop: NICE recommendation 1.1.10 is flat that you should not offer skin massage or rubbing to prevent a pressure ulcer³. Preventing pressure sores covers the daily checks and where the two guidelines part company.

The social worker: the assessment, the plan and the money that follows it

The social worker owns the arrangement rather than the body: the needs assessment of the person you look after, the carer’s assessment of you, the resulting care and support plan, the budget, and any safeguarding concern.

Two assessments, two results, and they are separate processes. In England and Wales the Care Act 2014, section 10, requires the local authority to carry out a carer’s assessment where somebody provides or intends to provide care for another adult and appears to have any level of need for support⁵, and the statutory guidance says that assessment must consider whether the caring role is sustainable and its impact on work and education⁶. Direct payments, meaning cash instead of arranged services, are available in England, Scotland and Wales from age 16 and are explicitly available to carers in their own right⁶.

See the care needs assessment for what the first one decides and the carer’s assessment for the second, which most carers never have.

The occupational therapist: equipment, adaptations and the assessment that unlocks them

The occupational therapist owns the question of how somebody actually functions in their own house, and the equipment that follows from the answer. Grab rails, raised toilet seats, perching stools, bed levers, bath equipment, chair raisers, hoists, and structural adaptations all sit here, and most of them are unlocked by an assessment rather than bought.

The argument for asking early is arithmetical rather than sentimental: around a third of people aged 65 and over, and around a half of people aged 80 and over, fall at least once a year, and the one-year mortality rate after a hip fracture is 31 percent (NICE guideline NG249, published 29 April 2025)⁷. Equipment is the cheapest intervention in this whole subject and the most frequently skipped. Adaptations and technology at home covers what the equipment and the sensors realistically do, including where they stop.

The physiotherapist, the pharmacist, and the two you may not have met

The physiotherapist owns movement: strength, balance, walking, and safe transfers. If somebody is deteriorating in how they get out of a chair, that is a physiotherapy question and it is also a falls question. Moving someone safely covers what a moving and handling assessment produces and the lifts no carer should attempt alone.

The pharmacist owns the medicines list in practice, is usually the easiest member of the cast to reach, and does not need an appointment in most systems. They can explain what each item is for, spot duplications and interactions, advise on formulations when swallowing becomes difficult, and initiate or contribute to the structured medication review under NG5².

The dietitian is the one families reach far too late. ESPEN’s 2022 practical guideline expects all older people to be screened routinely for malnutrition with a validated tool, at least annually in general practice⁸. If weight is falling, the request is a screening and a dietitian referral rather than a harder try at mealtimes: eating, drinking and weight loss covers when to stop cooking harder.

The speech and language therapist assesses swallowing, which is not obvious from the job title and is the reason coughing at mealtimes is a referral rather than a habit.

The discharge coordinator: the one name to get before anyone goes home

Hospital discharge has a named owner, and NICE and SCIE have written that down so that families can ask for it.

NG27 recommendation 1.5.1 requires the hospital to “make a single health or social care practitioner responsible for coordinating the person’s discharge from hospital”, and 1.5.2 says that person is “a central point of contact for health and social care practitioners, the person and their family during discharge planning”⁹. If you have no name, you have no coordinator, and the discharge is being run by whoever is on shift.

The same guideline sets out what should follow them home: a discharge summary to the GP within 24 hours with a copy to the person on the day of discharge, a discharge plan covering condition, medicines information, contacts after discharge, arrangements for continuing social care and health support, and details of community and voluntary services, given to the person and to everyone involved in their ongoing care “including families and carers”⁹. And recommendation 1.5.38: “A GP or community-based nurse should phone or visit people at risk of readmission 24 to 72 hours after their discharge.”⁹

The reason that call exists is measurable. In England, 14.7 percent of discharges resulted in an emergency readmission within 30 days across all ages in 2024/25, rising to 17.8 percent among people aged 75 and over (NHS England Digital, Compendium indicator I02040, published 27 November 2025, covering April 2014 to March 2025)¹⁰. If nobody rings you in the first three days, ring them. Coming home from hospital is the whole discharge window.

What are these people called where I live?

The roles are near-universal. The names, the employers and the entry points are not.

Role	United Kingdom	Ireland	United States	Australia	Canada
First clinical call	GP surgery, NHS 111 out of hours	GP, out of hours GP service	The person’s own doctor’s office, the plan’s nurse line, urgent care	GP, healthdirect on 1800 022 222	Family doctor, provincial health line on 811
Nursing at home	District or community nursing service, often via the GP practice and in many areas by self-referral	HSE public health nurse	Skilled nursing under Medicare home health: part-time or intermittent skilled need, homebound, face to face certification, Medicare-certified agency11	Via My Aged Care12	Provincial or territorial home and continuing care programme
Assessment and care planning	Adult social care at the local council6	HSE	State Medicaid agency for home and community based services, elected under four authorities with 47 states and DC operating at least one 1915(c) waiver13	My Aged Care, the single entry point12	Provincial home care programme
Equipment and adaptations	Occupational therapy, usually through the council	HSE occupational therapy	Durable medical equipment under Medicare Part B, at 20 percent after the deductible, plus state programmes11	Via My Aged Care	Provincial programmes
Discharge coordination	The named coordinator required by NG279	Hospital discharge coordinator	Hospital discharge planner or case manager	Hospital discharge planner	Hospital discharge planner

Who do I ring for what?

The short version, for the front of the folder.

• New confusion, a fall, a new fever, stopped eating or drinking, new or worsening pain: their own clinician, the same day. Not a service, not an email.
• A red or broken area of skin, a blister, a wound that is getting worse, a catheter problem: the community nursing service, today.
• Medicines: a side effect, a refusal, a swallowing problem, a list that has grown to fourteen items: the pharmacist first if it is quick, the GP for a structured medication review².
• They cannot manage the stairs, the bath or getting out of the chair: an occupational therapy assessment, and a physiotherapy referral if the change is in strength or balance.
• They need more care than you can give, or the plan is not working: the social worker, and ask for a reassessment.
• You cannot go on as you are: ask for a carer’s assessment in your own right⁵, and see getting help in.
• Something has gone wrong with a paid service: the provider first, in writing, then the regulator or commissioner. Choosing a home care agency covers complaints routes.
• You are worried somebody is being harmed or exploited: safeguarding, through adult social care, and say the word safeguarding.

How do I get any of them to talk to me?

Two moves, and they are worth doing on a calm day rather than in a crisis.

Ask to be recorded as the carer, on their notes and on yours. On theirs, it changes who gets called and who gets spoken to. On yours, it changes what is offered to you, and it takes about ninety seconds to arrange.

Settle the information-sharing question while the person can still settle it. Where they have capacity, their consent is what opens the conversation, and a short signed note is more durable than a verbal agreement that has to be re-established at every appointment. Where capacity is in doubt, what happens depends on the instruments already in place, which is the argument for setting them up early: see power of attorney and decisions and, for the harder version, when a parent refuses help.

You are not asking for a favour when you do this. NG27 tells hospital and community teams to recognise the value of carers and families as “an important source of knowledge” about the person’s life and needs, and requires that where a discharge plan relies on family or carers, the team takes account of their willingness and ability to provide support, their circumstances and their need for respite⁹. Being heard in appointments covers how to get that into a ten minute slot.

This is a call today, not a referral question

Knowing who owns a decision is useful right up to the point where speed matters more than tidiness. When any of the following happens, ring the person’s own clinician the same day and let them sort out who else needs to be involved:

• More confused than yesterday, or confusion that comes and goes through the day. Use the word confusion¹.
• Withdrawn, slow, drowsy, or stopped finishing meals, which is the quiet form of delirium and the one most often missed¹.
• A fall, even one they got up from⁷.
• Stopped eating or drinking, or urine gone dark and scant.
• New pain, worsening pain, or agitation in somebody who cannot tell you what hurts.
• A sudden change in continence, or a new fever.
• Redness over a bony point that does not go pale when you press it, or any new break in the skin³.

Who to ring: in the United Kingdom, their GP surgery, or NHS 111 out of hours. In Ireland, their GP or the out of hours GP service. In the United States, their own doctor’s office, or the nurse line their plan runs, or an urgent care center. In Australia, their GP, or healthdirect on 1800 022 222. In Canada, their family doctor or the provincial health line, 811 in most provinces.

Use the emergency number immediately for changed breathing, chest pain, one-sided weakness, changed speech, a first seizure, an unrousable person, or bleeding that will not stop: 999 or 112 in the United Kingdom and Ireland, 911 in the United States and Canada, 000 in Australia, 112 across the European Union.

Spotting when someone is getting worse is the full method. Getting the right professional matters on a Tuesday. On the day something changes, getting anybody matters more.