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The waiting game

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)

  • Geriatricians charge for domiciliary visits.

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  • Peter Mcevedy | GP Partner

    thank you, at least you found you had a clear benefit.

    I'm pretty sure we would have not had any benefit from a weekly round from the last Nursing home i was involved in. but that was because very little visits were generated by them.

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  • The reason care home patients require more GP visits - is they are supervised by poorly trained, poorly paid care staff who request GP reviews to cover.

    The more times they are seen - the more chance of hospital.

    There is a vast cohort who live at home - just as co-morbid as the care home population - who never ask for a visit year to year because they're not being stared at 24/7 by a CQC fearing care home manager / relatives.

    Early results will turn into nothing - and this will be scrapped a few years down the line as the unplanned admission scheme was/is.

    Probably created by the same muppetologists who created the unplanned admissions scheme.

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  • @ Anonymous | Sessional/Locum GP03 Oct 2016 11:14am from 10.36
    I agree that a weekly round would not be necessary for every patient and I am not giving unqualified support for the scheme in its entirety. I was trying to emphasise the fact that these patients often do not receive the GP care that they need.
    You quite rightly point out that many other patients have the same needs but I suppose this is a start which focuses on those who are well defined as being at greater need. The presence of "nurses" in nurses homes is tokenistic, and in my experience, is no indicator that these patients are in receipt of much more care than those at home with carers.

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  • Anon1:43 yes CCGs will have to pay for this, but GPs will not.
    We need to remember always to separate the commissioner aspect of being forced into a CCG from the provider part.
    If CCGs want/must do this then they must pay.
    Where they get the money from is only our concern if they try to take it from the LCS budget, then they will get a fight from the membership

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  • What a lot of bull* We already do with all the demand and workload.

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  • Why should commercial care homes not be required to, by law, to have a fully trained and qualified nurse supervisor at all times.This would help the NHS to avoid unnecessary doctor visits.

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  • Just "do the math" as they say in the USA. At least one hour per home per week makes a load of GP surgery appointments gone West. (and don't these nursing homes have nurses in them?)

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  • Why not get the benefits and insights of those CCGs which have provided this service to their care home patients before rolling out a half baked scheme.

    Even at £200+ extra per patient per year this is unviable for a lot of practices and if they think it will save money it won't, as if seen more often they end up in hospital more often. But don't take my word for it, there are CCG s who have had the full lifecycle of this and it doesn't save money. The service is better and the initial costs look promising, but burden on practices is immense.

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  • Anonymous | GP Partner01 Oct 2016 7:13pm -"It's a good idea if paid properly and you can spare a partner 1 afternoon a week which did require some reorganisation" what needs OVER and FOREMOST is GERIATRIC CARE ASSISTANTS/HCA-Geriatric and Geriatric Trained (if not yet)/Recruitment of Community MATRONS. The complex cases to GPwSI's in GeriatrIcs/Comm. Geriatricians. I am really tired about the "choice"; what needs being chosen is EXPERTS in Care for the Elderly, WHATEVER THE NAME. Maybe because I am a Locum I am more INTERESTED in TREATING the ILLNESS rather than the appealing of the CARER!!

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