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GPs buried under trusts' workload dump

GPs to do weekly care home rounds under new NHS England plan

GP practices around the country will be paired with care homes with the expectation of carrying out a weekly round, NHS England has said.

A report to the NHS England board meeting on a new 'enhanced health in care homes (EHCH)' model, published yesterday, says care home residents 'are not having their needs properly assessed and addressed'.

It says there should be one-to-one mapping of GP practices to care homes, with each resident having a named GP, across the whole of England.

GP leaders are warning that there are not enough GPs to carry out this level of enhanced care, and it will remove the concept of patient choice.

NHS England say that six areas are currently piloting the model, and are 'seeing early results' of enhanced primary care support, including 'a reduction in falls, prescribing costs, reduced ambulance conveyances and fewer avoidable admissions'.

National director of commissioning strategy Ian Dodge said NHS England intends to set out a plan for 'national rollout' of the 'EHCH' model later this year.

The framework published yesterday says: 'Wherever possible, there should be one-to-one mapping of GP practices to care homes within an EHCH as this arrangement simplifies care delivery (e.g. through multidisciplinary and interagency working between primary care and care home teams).

'This arrangement needs to respect patient choice. Each resident should have a named GP to ensure comprehensive assessment, problem identification and care planning.'

And under the plans, GPs have to carry out a weekly round in the care homes they cover.

The document says: 'A weekly "home round" should be held in each care home. This proactive round is a cross between a hospital ward round and a home visit, and it is crucial for reviewing and planning a resident’s care.

'Members of the team who participate in the "home round" are the resident’s GP, the care home team and other members of the local MDT such as nurse specialists and pharmacists.' 

Speaking at the NHS England board meeting yesterday, Mr Dodge said: ''We see significant interest across the country in adopting this model and scope for… rapid national rollout… and so later this year we intend to set out plans for national rollout.'

But GPC clinical and prescribing lead Dr Andrew Green warned that pairing practices with a GP was not in line with the NHS commitment to patient choice.

He said: 'The idea of having all the patients in one care home registered with one GP practice rides a coach and horses through the concept of patient choice, and could leave a patient without a functioning doctor/patient relationship.'

Dr Green also pointed out that there was not enough GPs to roll out this scheme across England.

He said: 'The real difficulty here is providing the recourses required, not only in term of money but in terms of staff too. Our 11,000 patient practice has 10 care homes and we would need another partner to deliver this scheme, a partner who simply doesn’t exist, and the workforce implications of this scheme make the promised 5000 extra GPs look rather paltry.'

Asked how the rollout of the new model would be funded, NHS England told Pulse it will 'set out further details on funding shortly', but said it is likely to form part of the 'sustainability and transformation plans' (STPs) that are currently being drawn up around the country.

A spokesperson added: 'Local areas will have discretion as to how to provide those services but it does outline some of the services that need to be commissioned and the benefits that can be achieved as a result.'

The news comes as in the past there has been calls for GPs to stop charging retainer fees for services provided in care homes and as one in five care homes claim to be overcharged by GP practices.

It also comes as the GPC is in talks with the Government about scrapping the current enhanced service for avoiding unplanned hospital admissions of frail patients from next year.

What are NHS England's new care models?

NHS England's new models for general practice - multispecialty community providers (MCPs) and primary and acute care systems (PACS) - will have budgets based on the population they cover, similarly to the GMS contract, but covering a wider range of services.

The idea is for the new providers to hold a time-limited contract (of up to 15 years) during which they are responsible for the health outcomes of their patient population, and they are paid based on this rather than specific activities they perform.

The main difference between an MCP and a PACS is that MCPs 'integrates core primary care with out-of-hospital services, social care, and some secondary care services where this is appropriate', while the PACS 'expands on this arrangement to include acute and tertiary services where it is wanted and feasible', NHS England says.

NHS England says that the EHCS model 'provides care for a segment of an MCP’s or a PACS’s population: namely those people who are living in care homes or supported living environments or who are at high risk of losing their independence'.

It says this is likely to include patients at highest risk of unplanned hospital admission and those 'with the highest needs, such as frail older people'. In all three models, NHS England's idea is for GPs to work as part of a larger multidisciplinary team with other health and care staff such as consultants, pharmacists and social workers.

NHS England has been told by the Department of Health to ensure half of England's population is covered by new models of general practice by 2020. NHS England, in turn, has delegated this work to CCGs, trusts and local authorities who are divided into 'sustainability and transformation plan' (STP) footprints.

Readers' comments (40)

  • We have been cornered into doing this already. Trouble is we are a smallish rural practice and value continuity and know our nursing patients really well. Now I find myself having to see patients who my partners are already heavily involved with and I have never met.
    One model does not fit all.
    Just pay us and leave us alone to sort out local clinical issues.

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  • Fine, I will take a morning off seeing patients in the practice, and who will see those patients?......the non-existent GP in hub of course.

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  • Wouldnt it be far more preferable that such patients remain under the care of a GP but that the CCGs employ a geriatrician/GPWSPI who's sole role is to visit homes.

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  • expensive and inefficient

    even if NHSE try to avoid paying for it - it'll mean 1-2 sessions a week doing non urgent work with little clinical relevance.

    The major issue with nursing homes is the lack of qualified nursing staff in them.

    They don't need weekly medical input - they need adequate nursing - its not rocket science

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  • FFS!

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  • Who's the nurse in charge of this floor?
    I am?
    Any problems?
    No idea, I've never worked on this floor before! They seem better but the family demanded a daily GP review, just like Jeremy promised….

    We have this tosh already, FFS pay for proper cover, the NHS funding is not intended for weekly Care home cover. they charge residents enough, if they want a home GP they can pay for that enhanced level of care.

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  • Sounds a good idea.But I dont think it will avoid admissions.GPs will still refer patients as nobody is ready to take the responsibility.

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  • It's pretty hard to avoid this already for nursing homes, given they are used as cut price hospices often, so it is time to be paid for the work already being done.
    To those who can happily triage away most nursing home request you must be confident in the nurses. At our local home 'doesn't look quite right' could be anything between a solitary cough that day or imminent death, with nothing the incomprehensible bank nurses say on the phone giving clues as to what reality is!

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  • and suddenly: POW ZAP WALLOP
    we are now all community geriatricians but the difference is that we are cheaper and espected to do all the work for very little money,
    sorted! (not)

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  • it will be backed by the RCGP and they will send out welcome packs with GP-COG forms to color in, then the GPC will oppose it for a couple of days before caving in and you will all have to do it except for locums who will opt out.

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  • We do it as an enhanced service for hospital step down patients, twice a week, max stay per patient 4 weeks. Max 10 patients, payment appropriate sum (this is not GMS). This nursing home has additional staffing for these patients, on a separate wing. Main let down still is social services delays in sorting ongoing care. Patient returns to own GP if goes back to residential care or own home in the original GP area, or appropriate practice for their ultimate destination. This is not the same as routine rounds for all nursing home patients, that would swamp us. This one home we do for 1 month then alternate months with a neighbouring practice. As a large practice we can cope but we are lucky to have just about a full complement of GPs (but will be short again in 6 months!).

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  • We do this already - we have two half sessions a week to do a round at the nursing home (NB when they say "care home", do they include residential homes?).

    In spite of getting a GP visit twice a week every week, the home still manages to call out the duty doc at least once a week on top of that.

    We are a whole session a week of routine GP appointments down, and struggle to meet demand, but in our case this may be almost worthwhile, as they were regularly calling us out to see 6 or 7 patients a day before this.

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  • I thought the Cardigans always say..."you should consider it a PRIVILEGE to see patients in their home environment"

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  • No. I am not a community geriatrician nor do I have time to play at being one at the expense of doing my own job properly. If NHSE wants this service, it needs to recruit and pay sufficient community geriatricians. We are not even paid a sufficient premuim to cover the daily drip feed of "urgent" visit requests that may ot may not be but one has to go in order to find out

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  • So easy for these people to dream up things for GPs to do. An entire government department of jerk offs charged with screwing around with our job description and micro managing our lives - intolerable

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  • Sounds like NHSE need to get some proper doctor with white coats, consultants,not the lazy good for nothing GPs who are cheaper than the pet insurance for a small dog per patient for a year and already do 90% of the patient contacts in the NHS.

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  • No. Don't do it unless it's funded properly....and fat chance of that!

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  • Answer is simple - employ geriatricians - or GPs for that matter to deliver the care for all NH residents - not on an individual practice level but on a locality/network/mcp/ccg level - scrap the AA DES.

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  • Been doing this for years for free until recently.
    Benefits us as we do all the visits in one session( usually) and benefits them because they get all their problems sorted in one .
    Recently found out that some practices were paid for this when we weren't
    Now of course we all get some payment.
    Then of course are the ANPs, who should also be doing this, but when they're too busy, we pick up the extra work( shouldn't it be the other way round?)

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  • We already do this as part of a LES in Scotland. Payment works out at £420 a week so justifies me or 1 other partner going in 1 afternoon a week. Means between us we get to know staff and patients well, have a chance to speak to relatives, update anticipatory care plans, assess capacity, complete DNACPRs and do polypharmacy reviews (generally stop most of their drugs). It's a good idea if paid properly and you can spare a partner 1 afternoon a week which did require some reorganisation.

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