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A faulty production line

Care homes ‘to stop paying retainer payments to GP practices’

Care home providers have announced they are to stop paying GP practices retainer fees to provide extra care to nursing home residents, in a long-running battle over locally agreed enhanced services.

Care England, described as the largest representative for the Care Home industry, said care homes have ‘called a halt to the unethical practice of GP retainers’, after providers claimed they were mostly paying extra for ‘basic’ services that should be provided under the GMS contract.

It also called on the CQC to monitor the provision of care given by GP practices to care homes, and for a change to the GP contract to ‘specifically state which services GPs have a right to charge for and which should be free’.

But GP leaders pointed out that practices paid to be retained by a care home under enhanced services were ‘going the extra mile’ and that providers were often overestimating what practices should be expected to deliver.

A previous Care England report from 2008 called for an end to retainer fees for GP practices. Now, in updated research, it said 30 of 34 care homes that responded to a survey were paying a retainer to a GP practice – but only two of these described the service they were paying for as ‘enhanced’.

It said one provider was paying between £1,000 and £2,400 per month for a basic service.

As a result, it said care homes had decided to no longer pay retainer fees.

The chief executive of Care England, Professor Martin Green, said: ‘Our members will no longer pay retainers to GP practices; this should be no surprise to GPs as we have been making arguments regarding their unfairness for many years.’

It also called for NHS England to review what constitutes an enhanced service, and for the CQC to ‘monitor the practices of GPs in this regard’.

Professor Green said: ‘We need clarification as to what differentiates basic and enhanced services from a GP. We accept that enhanced services can be paid for and that these arrangements can be independently negotiated between a home and a practice, but as it stands the definition of a basic service offered in the GMS contract is far too vague to enable negotiations to take place in many areas.’

Dr Richard Vautrey, deputy chair of the GPC, said: ‘Practices when they are paid a retainer will go the extra mile – for example doing extra ward rounds, doing regular reviews when patients aren’t necessarily unwell,  they are much more proactive – and this in many ways reduces the costs for care home owners.’

He added that practices themselves wanted ‘greater clarify about the situation relating to care homes’ because ‘many patients are being inappropriately placed in care homes, leaving practices with huge responsibilities for caring for people in the community without the resources to provide it’.

He said: ‘We would welcome NHS England to invest properly in extra services for patients in these environments.’

Last year, the chief inspector of primary care, Professor Steve Field, said he was ‘disturbed by… newspaper reports about GPs refusing to talk on patients from care home unless they get a fee’.

Readers' comments (30)

  • Here we go. Here we go ....

    Round 26

    Ding ling ling

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  • more cac
    we used to have to do daily ward round rounds pretty much at some of the care homes we served locally; we had to implement this as some of them would call us several times per day, often even after we had visited because of poor communication from nursing staff.

    frankly id rather be shot of nursing homes anyway. we used to always get a call after anything was wrong and the staff would simply absolve themselves of any responsibility by writing "gp informed" in the patients notes;

    more dumping i suppose and as always in this game, less money..........GP LAND IS THE DUMPING GROUND OF DREGGS

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  • when nursing homes employ adequate numbers of nursing staff we'll make progress.

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  • We had a nursing home on our patch who no longer wanted to pay the modest retainer we were charging.

    Not a problem - we stopped the routine ward round and asked for ALL mobile patients to be brought to the surgery (at their cost) - ie basic GMS care. They soon realised that it was easier the original way around...

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  • We have unrealistic expectations from care homes about our duties. Many fail to understand that they get paid more in a day to look after a patient then we get in a year.

    My particular problem is when they use GP practices as a 'free' way of underwriting risk. Or when they ask GP practices to conform to local policies like signing the mast sheet or sending changes in prescriptions in writing.

    We work very well with our care homes - but have a local LES which helps us. If I were in an area without a LES or funding was being withdrawn I would be sticking solely to what I am contracted to do.

    Perhaps offering private work (like sending written confirmation of prescription change) for a very high private fee (£50 each time).

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  • Locally, we don't receive any such retainer payments.
    If they were being paid anywhere else, practices need to consider stopping 'enhanced work' e.g. home visits for those who can be brought to the practice etc.

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  • Most of these places are like hospital wards those though, full of desperately ill people often in need of end of life care. In a hospital you would have at least one SHO to hand full time so it's not difficult to see why practices can find themselves subsidising the profits of the owners. It's almost impossible to refuse a home visit for such patients these days without serious risk to both parties. Perhaps it would be better to nationalise them all and bring them back under the remit of the NHS like the old cottage hospitals?

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  • Dear All,
    We went through this last year. We pointed out that our contract allows us to decide whether a patient is seen, when they are to be seen and where they are to be seen as well as by whom they are seen. So routine visits to nursing home residents are NOT core services. They are an additional service. Furthermore the ONLY issue the doctor has to take into account is the medical problem (thats what it says in the regs). So a lack of sufficient staff to is not a legitimate reason to visit. We also outlined that a whole range of the services we provided to nursing homes lay a long way beyond core services. Once this had been made clear to the nursing homes they acknowledged these "additional services" and were happy to continue with our retainer. As Baroness Jolly’s initial opening remarks in the Lords debate on this said; “GP practices should ensure that any services provided to care homes for which a retainer is charged are not those currently provided under their contract with NHS England.”
    Quite simple really.
    Paul C

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  • Retainers rarely cover the cost for the actual care provided. You have to calculate the income after tax and NI to see if it is worth it

    Regular ward rounds?? Are actually expensive.

    We have a LES in our area but have not taken it on.

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  • why is it that everyone thinks they can get a free lunch out of primary care?

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