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How we look after all care home residents in our area

Dr Khalid Alshawy explains how his team covers all the care homes in Salford

Name Salford Care Homes Practice, Manchester

List size 1,084

Patients over 85 650, or 60% of the list

Full-time equivalent GPs 3.6

Our practice covers all the care homes in Salford

More than half our patients have dementia. This raises particular challenges for patient management, for example, clinical, communication and legal issues. We are an APMS practice and our funding is based on a set of key performance indicators reflecting the patient group we care for. Meanwhile, we still have to work hard on the QOF and have achieved the maximum points.

Being part of a large trust saves time

We have the support of a Salford Royal NHS Foundation Trust, which is our biggest advantage. This gives us HR support, recruitment, premises and training. We are fortunate that we are able to use the trust’s infrastructure for things like CQC inspection preparation, which saves us time and work.

All of our GPs are salaried or locums

Each GP at the practice has been selected for being passionate about working with the elderly. Our practice does not have ‘partners’. As well as GPs, the team includes administrative staff, nurse prescribers and healthcare assistants. The practice nurse undertakes our QOF administration.

We have a multidisciplinary team approach: we have a community geriatrician for a couple of sessions per week, a dementia specialist nurse and we also work in partnership with the local mental health trust.

All our staff have specialist training

We recognise that a role in the practice calls for a particular set of skills. We advertise widely and offer candidates the chance to shadow clinicians before deciding whether to apply for a role. It can be a challenge but we recognised early that it was important to recruit a team – both clinical and non-clinical – whose members had the required skills. We give all staff specialist training. The practice staff access the learning opportunities available from both the CCG and the trust, and we support them to undertake further education such as the Royal College of Physicians’ Diploma in Geriatric Medicine.

Some of our GPs have a special interest in dementia. We train receptionists in dementia awareness  and end-of-life administration procedures.

GPs triage all calls and visit if needed

Because of care homes’ routines, our telephone lines get very busy at certain points of the day. To improve access, we have increased the number of lines into the practice. Calls are filtered through to the appropriate team. GPs triage all calls on the day and carry out visits when clinically indicated.

Laptops allow mobile records access

On many of our visits to care homes, we need to access the patient’s records from the bedside. We have worked with the trust’s IT team on a mobile solution, so we can access records via password-protected and encrypted laptops.

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Readers' comments (7)

  • informative.Does not cover how this practice got the care homes on their books? Is it chance or active registration

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  • This is a "virtual community hospital" and a clinically appealing model at 300 patients per whole time equivalent GP.
    As Dr Maheswaran intimates there may be some substantive negative issues if people are "forced" to move to the practice on entry to the care setting- especially with the vulnerable elderly group.
    it would be very helpful to know contract type and remuneration- clearly it cannot be GMS from the parameters described- but it is immensely commendable as a clear clinical quality model of delivery.
    I would be interested in hearing more.

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  • The important thing to note is that their average list size is 300 !

    We are trying to look after everyone with a list size of 1800/WTE.

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  • it would be nice to have the funding model for this, what is the effective funding per patient?

    All teh problems with UK primary care seem to be due to this simple issue. If your effective funding per patient is too low - you can't afford to meet the same targets

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  • A variety of business models are likely to emerge for the medical support of care home residents, there are many attractions but I would commend time be spent ensuring the purpose is well defined for each patient in terms of their life trajectory. The discharge rate from care homes generally exceeds mortality and so how the current model interfaces with more traditional GP is of interest.

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  • Azeem Majeed

    The GMS weighted capitation formula used to allocate resources to general practices is a blunt instrument and does not work well for patients with complex health needs. For these groups of patients, needs-based funding mechanisms are more appropriate.

    Patients living in care homes have complex health problems that require significant input from GPs and community staff, as well as skilled care from the nurses who work in care homes. Residents of care home are potentially high users of hospital care as well as having very high prescribing costs, and additional investment in primary care and community services can be highly cost-effective, as well as improving the care these patients receive and their quality of life.

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  • As far as I understand it eh Carr Hill formula has a weighting for nursing home patients of 1.5. The actual weighting factor should be 4.5. Nuff said. Carr Hill might be a less blunt instrument if teh money followed the calculations!
    Paul C

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