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Care England couldn’t care less

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Care England may care about its care homes, but, as far as GPs are concerned, it seems it couldn’t care less. Because it has decided to withdraw retainers it’s currently paying to practices. And it’s calling for a revamp of the GP contract to clarify what basic general medical services care homes have a right to expect and which services might reasonably attract a fee.

Actually, that’s not a bad idea. Because it’s likely to prove the exact opposite of what Care England suspects: the truth is that most practices provide services to care homes which, in terms of quantity, quality and hassle, are way over and above bog-standard GMS.

We certainly do in our patch, given that care home staff always seem too stretched to bring patients to the surgery, call us sequentially through the day for visits to different inmates in the same home, send random urinalyses by fax for our attention with no clinical context whatsoever, have a vault-full of protocols all of which end with, ‘Call GP, now’ and so on ad nauseam.

And many practices, like ours, do this for no extra funding at all, aside from a risible extra few quid chucked in the global sum.

But actually, funding isn’t the point. So I hope this problem isn’t resolved in that predictable, linear medicopolitical way which goes, extra work →extra funds →issue solved. Because, even if I do earn more for care homes, they still remain my problem. Sure, I’d have extra money to pay for more staff. But then I’ve got, to find, say, a care home nurse practitioner, employ her, train her and then deal with the fallout when she goes off sick with stress after two days.

Ask any GP: it’s not more funds we need, it’s less work – and care homes are an excellent case in point. Yes, I want the residents to have quality care, but I simply don’t have the hours in the day to provide it.

So give the problem to pharmacists, to public health, to community geriatricians or even, for all I care, to a crack squad of government-funded, extended role, elderly-friendly Labradors. Just don’t give it to me.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter@DocCopperfield  

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Readers' comments (8)

  • Totally agree
    Can't wait for it to backfire on them so hard. And great chance to say f*ck it, whatever you pay us, we ain't doing this anymore

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  • Vinci Ho

    Some 'poisonous' money is just not worth to swallow?

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  • Care homes generate a disproportionate amount of work - and the extra funding we get hardly covers the extra work involved.

    Private GP practices have been known to de-register care home patients - not profitable enough.

    We should stop the retainers and provide Basic GMS servcies - that means patietns who are able to leave come to the surgery - if they don't have the staff that is upto the home and not the surgery. Same with Mars sheets, extra advice etc etc

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  • I fail to see how in this particular case, where the withdrawn retainer not in place is going to backfire on the home in question.

    If the practice does provide the services "way over and above bog-standard GMS" then this represents an unfunded drain on practice resource, which could be better used in the provision and the improvement of obligatory work. How is this being justified to the rest of the practice list size?

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  • Hadrian Moss

    Actually, elderly-friendly Labradors isn't a bad idea, residents would love it and personally I'd spend more time patting the dog than listening to the staff!

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  • MAR sheets! Please tell me you do not fill these in.
    Your responsibility i to provide an appropriate prescription, as decided by you.
    Any MAR charts can be filled in by a pharmacist or not used at all.
    They are not a GP responsibility.
    Just say no

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  • Daft question, but why would you visit a non-bedbound care home resident? Their transport problem is not your responsibility and is their problem to solve if you offer to see the resident at the surgery.

    I cannot understand at all why so many GPs will visit patients who are capable of days out with their family or trips to OPD with the simple expedients of walking sticks/wheelchairs/cars.

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  • As Tony said tge problem is caused by protocols ending in "Call GP". A local CCG has trialed and now commissioned a community support and TRAINING team to ensure that care homes stop referring every cough, sniff and ache to GPs, looks promising so far.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder