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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)

  • this is awful - care home patients can get sick more than once a week - why not daily rounds including weekends from 8am to 8pm a day. Surely GPs are best placed and they can do their other (best placed) jobs in between. come to think of it care home patients can get sick OOH as well - we need to look at that as well.

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  • My 11,000 practice has 200 patients in homes. Many other local practices refuse to take on care home patients. That's going to be an awful lot of wardrounds. Who will see the other 10,700?

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  • Have done this for years - originally as a paid pilot through the PCT - found it saved time as has massively reduced call outs to the homes as most things wait for the weekly visit - staff like it as consistent message and patients and families also seem to like the continuity. Difficult to get other practices in area to adopt - we did try dividing homes out but apart from ours, little progress in changing. Paying a LES would probably accelerate this!

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  • The reallity is that this group of patients, is often neglected at present. Many of the reader's comments made about lack of GP workforce, inadequate nursing quality in homes and workload are valid. But to claim that we are being asked to become community geriatricians is wrong. We are not.
    These patients mostly need GP expertise and care but they just don't get enough of it. If GP's feel that these patients are in need of a geriatrician they can always refer. Let us not conflate volume of work with complexity of work.

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  • I saw this was being organised by Ian Dodge. No track record for GP-friendliness or realism...

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  • 10:36, still not sure why patients in nursing home need a weekly visit, they are already getting 24 hour care and support. What about all the single vulnerable elderly and disabled patients (who have next to no support as care being cut for "efficiency") who are not getting their weekly visits - surely their need is much greater? Maybe we should be visiting everyone over 75 every week? Completely unworkable and financially unviable. No other patients get a weekly GP appt all still for the same basic funding. Are we really worth only £2 per week to go out and in our car, pay insurance, time etc to visit someone weekly at their place of residence? Also amazing how many patients in homes manage to get to hospital OPA but cannot come to the GP surgery!

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  • I am just so relieved to have walked away from GP 15/12 ago. My main reason for departure was the popular perception that old age is a treatable illness and the responsibility for it's prevention and treatment is the GP's. I realise my thoughts might offend some but when one of the commonest comments from carers/staff/relatives and pretty much anyone visiting many Nursing Homes is 'I hope I never reach this state!' then might it be time to consider what we are trying to achieve here. On my farm when animals are immobile lying in their own excrement and unable to feed the vet is called to do the decent thing, this applies to both livestock and pets. When patients were in that condition I recall nappies and PEG's. I think that rather than weekly visits to assess, what we actually need is a frank discussion about quality of life issues and then a sensible decision about treatment or it's withdrawal. Then we need to explain to the politicians, journalists and general population that life expectancy has increased almost 20yrs in the last century but you might not enjoy or want to experience the last bit.

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  • Peter Mcevedy | GP Partner03 Oct 2016 9:00am

    Are you doing this as an unpaid privilege?

    If you are , do you not recognize that you are a part of the problem (all be it by being very nice)?

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  • Not sure if anyone has realized - this is to be paid out of STP scheme.

    CCGs are forced to form STP with no funding provided upfront for organizational work. Employing managers and directors does not come free. Now the transformational money is meant to address such short form but other schemes such as this seems to be hijacking it.

    Am I the only one who wonders when the SHAs (sorry, I mean STPs) are established, we suddenly realize all such funding is in "the baseline" and no new real money added to healthcare. Effectively, as members of CCG, we will end up doing this for free?

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  • 11.42
    Actually was paid handsomely for pilot and found that it actually saved time and visits during this. So yes, we do it without payment now but because it is prudent to do so in the homes we have chosen. If a payment system comes in, we would welcome it and it might encourage a broader take up especially for those homes which are less viable but I make no apology for saving my time and offering a better service at the same time. Has also reduced the prescribing in this home massively.

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