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GPs go forth

One in five care homes claim to be 'overcharged' by GP practices

A survey of care home managers has suggested one in five feel they were ‘overcharged’ by GP practices for their services.

GP practices sometimes charge retainer fees for providing services to care homes which go above and beyond the core GMS contract.

But a survey of 285 care homes in England found that managers feel GP practices are charging them for services that would be free to patients not living in care homes.

The Alzheimer’s Society, which carried out the investigation, said: ’[O]ne in five care homes surveyed are being wrongly charged by GP practices for services that should be free on the NHS – up to as much as £36,000 a year.’

It said that the total cost of GP charges to care homes is estimated to exceed £26 million a year, at an average of £12,191 per care home.

The charity added: ’The money that care homes are spending on GP services - that are free on the NHS to all those living in the community - could be much better spent on one-to-one care for people with dementia.’

But, responding to the report, the RCGP said the ’current funding to provide a quality GP service to these patients is extremely challenging for many practices’.

It added that it was ’within the prerogative of an individual care home to arrange services for their patients’ that are not covered by NHS contracts.

RCGP honorary secretary Professor Nigel Mathers said: ‘We need better co-ordination of approaches for referral, assessment, and treatment across the boundaries of primary, secondary and social care – including care homes - so that we can improve the services, and access to services, that will help patients with dementia to live healthy, independent and productive lives for as long as possible.’

Last year Care England annunced care homes would stop paying retainer fees for GP services 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.

Readers' comments (15)

  • "and that providers were often overestimating what practices should be expected to deliver."

    Remember that the practice gets only 80 pounds or so to look after a patient for a year. (under their core contract)
    A care home gets that amount to look after a patient for about 24 hours.

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  • It's very simple: if a care home wants standard GMS service there should be no extra fee. Unfortunately this means that patients that are not bedbound will have to be brought to the surgery at the homes' expense with a staff member provided. Being in a care home does NOT entitle automatic visits.

    If they want the "frills added" service that includes non-GMS stuff - like a weekly ward round, visits for non-bedbound patients etc, there is an additional charge. This is not fixed and to be negotiated between both parties.

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  • 5.47pm...ever been to a 'care home'? not many 'frills' to be found there.shame on them

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  • Care homes are unfounded hospices for the old and voiceless who are dumped there as new patients - 'discharge to community death' box ticked and free gp card imcluded.

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  • sadly it it becomes unfunded, given the demand on our time GPs will sadly have to drop out of providing this service. The CCG will have to find a way providing it, however, it will be more expensive. If we had enough staff, were adequately funded and had manageable demand it wouldn't be a problem. I did an on call recently and every call was an 'emergency' - were they - nope but people had learnt to say an emergency to bypass waiting. Sorry but don't have time to do unfunded work.

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  • Yes. Let them stop paying my fees and I'll insist on seeing ambulatory patients in Practice rather then on visits as per current arrangement.
    By the way, if report indicates that fees average from 1 to 2.4 K pcm, it means that my Practice is significantly undercharging and it's time to re negotiate our contract. We look afterwards 60 beaded facility, weekly rounds plus emmergency visits for mostly ambulatory patients. For less than 6 K a year.
    Just curious if anyone else thinks they are charging less than we should?

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  • In Canada being a dctor who visits a care home is a completely separate job to being a family doc. it pays quite well I believe and that's by the standard of the average GP earning 180k sterling. I believe its government funded however.
    They really have UK GPs by the balls and then harp on about overcharging for something they choose to purchase.
    12K per care home split between however many GPs for lots of extra visits sounds like a bargain to the carehome and an insult to the GPs to me. What is it 1k per year per GP for probably 100+ visits and 15 ward rounds. Great.

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  • Hey Maureen,
    Seeing as everything is quite literally perfect in GP Land (I type this deafened by the stampede of FY1s charging to get onto GP training schemes) could you spare us 5 mins of your time for the College to provide clear, accurate and legally relevant (please not the usual - GPs could and should provide everything you can ever want and they will pay for it because that is what SoS wants me to say) guidelines for us and Care Homes so they know what they should be getting under GMS and then they might stop ringing 3 or 4 times per day because they want a visit for Mr Smith who sneezed at lunch and the family are demanding a visit (before taking him out to the garden centre).

    Unless you do this job you have no idea just what a burden on time and our resources covering care homes is. We have about 15000 patients of which 80 are in 3 care homes and struggle to keep them under control with 3x 4 hour sessions per week to try and avoid the numerous vacuous calls each day.
    That works out as 12 hours per week spent on 0.5% of our patients and as we (practising GPs) know they aren't those most in need because they are living in a nursing home with 24 hour nursing care. Means there is no time left to provide that level of care for anyone else, many more of whom need it. Therefore if nursing homes want a personalised GP service, I'm sorry but they should pay for the Dr to provide it. Time to remove care homes from normal work.
    If you provided that care to the 2% on the unplanned admission list that would be for 300 people that would be 60 hours per week just for them (and that's rushing to get things done).
    Not sure when you're expecting us to cope with the several hundred others each day who come in with complex chronic diseases and lists of problems. Sorry but what we manage to do for a pittance (per patient) is phenomenal but also unsustainable….

    FY1s you would be out of prison faster if you got a double life sentence than working as a GP to retirement, with probably more control over your life and better human rights than a GP currently receives!

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  • The NHS isn't free. Everything it does cost money and the older the population gets the more it's costing us all. Concentrating large numbers of elderly people in one spot and then expecting the local NHS funded GP practice to take on the vast amount of clinical work involved is no small task. Expecting this all to be provided as part of routine 'free' (nothing in the NHS is free) is naive and/or simplistic at best. There's a care home across the road from my practice with approx 500 flats each one with a 80/90 something resident, most of whom expect a home visit every other week simply in the basis they're old and have a right to one. Same as having 500 flats filled with working 20 somethings ...I don't think so. Get real.

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  • Weighted capitation payments are much higher for these care home and elderly patients and not the same as 20 something's!

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