BACKGROUND: The incidence of epilepsy increases with age, especially in people diagnosed with dementia. Seizures in an elderly population are likely to have a focal onset, for which sodium channel blockers are the drug of choice. This study reviews the clinical needs and care of people with epilepsy (PWE) in a city wide care home service and assessing the impact of a GP with Special Interest in epilepsy (GPwSIe). METHOD: The clinical notes of PWE, or with a documented single seizure, who had at any time been under the care of the service, which included a GPwSIe, providing care to all nursing and residential homes in Chester were reviewed from June 2020 to December 2022. RESULTS: In the 102 people in the study, thirty eight (37%) had clinical input from a GPwSIe with 82% having positive outcomes. No referrals were required to secondary care. CONCLUSION: This first comprehensive study of epilepsy in UK care homes has revealed a significant workload. A dedicated care home service, which included a GPwSIe, can meet that clinical need, prevent secondary care referral, and facilitate education for colleagues and carers. National Institute of Health and Care Excellence (NICE) guidelines for management of seizures, likely to have a focal onset, and in a population who might not be suitable for standard investigation, could be simplified for this group of people. The service is a good example of how the Enhanced Care Home Framework can facilitate improved care.