The story of medical care in care homes has been some pockets of excellence, a lot of mediocrity and some examples of the absolutely scandalous.
We produced a report three years ago called Can We Afford the Doctor?, which reflected the above picture. Many care homes reported being compelled to pay retainers because GP lists were full. In this scenario, the PCT assigns a GP to the patient – often resulting in several practices visiting a home. The NHS is supposed to be free at the point of service but the exception seems to be residential care, where some GPs were able to charge the earth for doing very little.
On the other hand, there are also some very good examples of quality care emerging, as a case study from Nene Commissioning shows.
The case studies presented here show some of the best – with a proactive and preventive approach alongside the reactive care that patients do need from time to time. The very commendable work in Sheffield where they have set up a GP practice to deal with the needs of patients in each care home is something I would like to see repeated. And in the best of scenarios, the NHS reforms represent a real opportunity to extend models such as these much more widely.
When clinical commissioning groups such as these get the care home system right, the number of people ‘blue-lighted' to the acute sector will be much diminished and there will be a much better quality of life for the residents.
There will also be significant benefits for the care homes. If they are not having to manage the interface with the acute sector and are doing far less drug administration, there are massive staff benefits in terms of the time they have available to do other work. If we get it right, everybody benefits.
Where GPs are trying to be more systematic and proactive, care homes need to think about how to make things work better at their end. They need to be asking: what information does the GP need to be as productive as possible during their visits to the care home? It's all about the care home staff understanding how the GP works. There is a need to foster a clear understanding between the home, the doctor, the resident and the family – and they all need to work together. Click here to find out how each care home has its own culture that needs tapping into.
To take the best advantage of the opportunity now on offer, we will all need to think creatively. And I believe there is a need for a national initiative to get the whole system to think in a holistic way.
Up until now, we've had as many fragmented individual practitioners as there are care homes.
My personal jury is still out on the health bill, but the secretary of state has a responsibility to ensure healthcare is free at the point of need – for absolutely everybody. That includes care home residents. The Department of Health needs to send very clear messages to all parties to get this work rolled out across the whole country.
‘Redesigning care pathways to reduce emergency admissions' will be one of the track sessions at this year's NAPC annual conference. Look out for the conference brochure in next month's Practical Commissioning. Book your place today at: www.napc.co.uk/annual
