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Care home funding cuts leave GPs 'time bomb'

By Lilian Anekwe

Exclusive: GPs are facing a mounting crisis in their management of patients in care homes, with a Pulse special investigation revealing swingeing cuts in funding and an alarming rise in the number of ‘critical incidents' reported to the NHS.

Our investigation exposes sliding standards of care and alarming holes in the services available to GPs, after gathering data under the Freedom of Information Act from primary care organisations and the Care Quality Commission.

The Department of Health this week told Pulse that under its plans responsibility for funding practices to manage patients in care homes, provide nursing cover and commission support services would all be falling to GP consortia.

That leaves GPs with a huge task to revamp underfunded and failing services, with one warning that the profession was faced with a ‘time bomb waiting to explode'.

Responses from 115 PCOs show they have cut funding on medical and nursing services for care-home residents by 11% in the last year, from an average of £586m in 2009/10 to a forecast spend of £520m in 2010/11.

There is evidence that even before those cuts, standards of care were slipping, with the rate of ‘serious untoward incidents' soaring in the preceding 12 months.

The number of incidents reported to PCOs rose by 80% in just a year from 864 in 2008/9 to 1,590 in 2009/10. They include reports relating to standards of care, cleanliness, falls that in at least one case led to death and ‘severe, long-term or permanent harm' to residents.

Our figures come just a week after the CQC took enforcement action to close 34 care homes where it judged ‘risks to health and welfare were too great'. The regulator's concerns included verbal and psychological abuse of residents, poor medicines management and failings in medical and nursing care.

GPs face a funding lottery, with just 44% of PCOs providing access to a local enhanced service to support work in care homes, 22% providing access to dedicated specialist geriatricians and 62% offering support by community pharmacists in reviewing patient medication. Even access to basic services such as tissue viability nursing and continence advice was not universal.

GP consortia could be left to investigate waves of complaints from practices and relatives over the management of patients in care homes. In the five years to April 2009, the CQC said there were more than 36,000 complaints received about residential homes and 69,000 across nursing homes as well.

Some 4,626 complaints were about poor attitude among care-home staff and 4,760 about staff competence or skills. More than 400 related to suspected sexual abuse.

Dr Bharati Shah, a GP in Plumstead, south-east London, said: ‘Care of patients in care homes is appalling at the best of times. There seems to be difficulty in getting proper medical care and it is fragmented out of hours. It is a time bomb waiting to explode.'

Dr Gillie Evans, a GP in Peterborough, said: ‘Many of us feel we could do this better. But we need more time and time means financial support. Otherwise all of the responsibility falls on general practice, just as we are being asked to take on a huge change in how we work.'

A spokesperson for the Department of Health said: 'Care homes residents are entitled, as are all citizens, to the full range of NHS services, free at point of delivery. We expect the NHS locally to ensure that residents get the health services they need.

'The NHS has actually increased funding to meet the costs of a nurse that's needed in a care home. It is the responsibility of care homes to negotiate with primary care trusts over local contracts for the provision of a continuing healthcare package for those assessed as eligible for NHS-funded continuing healthcare.'

Key findings of Pulse special investigation

• Funding for medical and nursing services for care-home residents fell by 11% in the last year, from an average of £586m in 2009/10 to a forecast spend of £520m in 2010/11.
• The number of ‘critical' incidents reported to PCOs rose by 80% in just a year from 864 in 2008/9 to 1,590 in 2009/10.
• GPs in 90 of the 115 PCOs, or 78%, have no access to specialist geriatricians and in 99 of the 115 PCOs, or 86%, have no access to specialist geriatric nursing.
• Just 44% of PCOs provide any funding through LESs to cover the extra workload from nursing and residential homes, and even that money is not safe, with just 37% committing to LESs for next year.
• Half of PCOs provide no additional funding for GP reviews of antipsychotic medication, and 38% commission no support from community pharmacists.
• Some 14% of PCOs provide no access to tissue-viability nursing, and 10% have no access to continence advisers.

Responsibility for funding practices to manage patients in care homes will pass to GP consortia More on...

Click here for the full results of our special investigation

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