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Independents' Day

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)

  • Took Early Retirement

    Ideally, there should be a massive capitation fee for all Residential Home patients. Or, even better, a massive item of service fee for every visit.

    We never got a retainer. We only had a couple on our patch in recent years but they generated masses of work. It is really just like looking after people in a long-stay hospital. (Which is not GMS)

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  • we have on average 6-7 home visits a day to the local nursing homes, plus 'ward rounds' at 2 NH once a week on top of this. this is not core work.

    start making NH bring their residents to the surgery or charge them retainers. simple.

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  • Just Your Average Joe

    Hi Paul Cundy

    Please could you kindly help out all our colleagues including my practice by working up a quick list for us of the long list of NON CORE services you provided to the care home, so we can check against it.

    This would be very much appreciated.
    Kind Regards

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  • I have recently started speaking to londonwide LMC on this point. they will be looking to draft guidance for GP's on this point. Wessex LMC that have produced very good guidance on this topic.

    I am happy to engage with Care England on this point.

    A retainer and LES do not take into account the extra work that is generated.

    the care home businesses do need to restructure themselves in light of the new relationship with general practice.

    failure to bring a mobile resident to the practice would leave the care home in breach of their duty of care. lack of transport is not a reason for home visiting from a GP service.

    I would welcome a review by NHS england to clarify what our different duties are.

    Muh work was done in good will with care home residents. Care England have really sapped that and it is a shame that they did not choose to be more wise.

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  • The cost of hiring just 1 full time staff member, having a driver and a van to transport the patients all day long, would massively on a multiple of possibly 10 times outstrip the meagre retainer fee paid per annum by several local care homes.

    Care England wanting a return to core GM provision will find they have shot themselves fatally with this seriously misjudged decision which will back fire.

    They can have the retainer and I will be pleased to stop all the extra work that goes into the weekly rounds and reviews, writing in their records and putting up with their demands.

    They can ring for an appointment and bring in the patients to the surgery like everyone else.

    Watch them come begging for a retainer to provide the extra services again.

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  • Something needs to change. The Longevity Timebomb appears to go largely unacknowledged while the press twitters on about the red herrings of "obesity" and "immigration". And people in care homes take up a huge and increasing amount of our time and attention, and the pay for care workers is so poor that they really cannot be expected to know how to give even the most basic day to day health care or carry the smallest amount of risk personally. These retainers, even taking the highest sum quoted, wouldn't scratch the surface of the extra work generated by our care home residents.

    Many care home residents are very poorly people who would, in the past, have been in hospital being nursed. by actual nurses with a consultant physician overseeing their care. That was probably excessive in a lot of instances, but putting those people in the community, in growing numbers, for GPs to manage with little support is a scandal.

    Elderly care needs better funding, and I would gladly vote for care home residents being taken out of general practice workloads and care organisations being obliged to employ a suitably trained doctor for a realistic number of sessions per week at an appropriate rate of pay to look after their residents.

    But ramping up the care home fiasco is just another facet of the plan to collapse NHS general practice, isn't it?

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  • "writing in their records and putting up with their demands. "

    Interesting point - there is no obligation to write records other than in the medical record (ie at the surgery).

    Obviously a copy of each entry would be available under the DPA for the usual fee..

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  • Wow you surveyed 35 homes - so that's less than we have in half our CCG area. Come back when your data backs up your conclusions, and when the people answering actually understand what core services means.

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  • Peter Swinyard

    Our small (5000) patient practice used to look after a 61 bed EMI nursing home and took a retainer of £7000ps for non-GMS work. It took one partner a half day a week plus at least 1-2 calls a day to be "GP informed" of a temperature which had risen to 37.1deg or someone (with COPD) who had coughed.
    A change of matron meant the home became very poorly run.
    The retainer came nowhere near covering our extra costs and we withdrew (with lots of notice etc) once another practice agreed to take it on. (for much much more than we were offered!)
    This is real work for real patients as others have said. but it is not really funded.
    The long-stay geriatric wards were certainly not ideal. But dressing them up as "nursing homes" is not either (and I speak as one whose father spent the last 5 years of his life in one).

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  • Azeem Majeed

    As Dr Gold indicates, the ideal solution would be for care home residents to be taken out of the Carr-Hill weighted capitation formula and funded through a separate needs-based mechanism. Their primary care services could then be provided for either through a dedicated multi-disciplinary nursing home team that had the right mix of medical and non-medical professionals; or by general practices that received funding through an adequately resourced Local Enhanced Service (LES). Care homes vary considerably in how much medical input their residents need. Some care home act as ‘step down’ facilities for patients discharged from hospitals and their patients need a lot of medical, nursing and paramedical input. In some other care homes, the resident population is more stable and needs a lower level of medical input. Hence, a ‘one size’ solution is not going to work and each care home needs its own management plan and funding envelope.

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