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GPs go forth

BMA and NHS in talks over funding for networks with multiple care homes

Funding arrangements for primary care networks (PCNs) in regions with more care homes remain 'unresolved', NHS England has admitted, despite its new proposals requiring GPs to visit residents fortnightly. 

An NHS England official said they could not confirm how funding would be distributed to ensure PCNs that have to carry out more care home visits get paid more.

They hinted the extra funding could be drawn from NHS England's investment and impact fund, designed to reward PCNs that make 'strong progress in delivering the service specifications'.

The revelation was made during an NHS England webinar last week on the five new draft service specifications PCNs will be required to deliver from April onwards.

During the event another NHS England official also suggested the organisation was rolling back on its service specification for care homes, saying the entire multidisciplinary team - rather than GPs as individual practitioners - could be expected to carry out visits.

In a webinar held on Tuesday, Ali Sparke, NHS England deputy director for contracting and incentives, said the distribution of care homes means networks should not receive an equal share of funding to carry out the network contract DES requirements. 

In response to a question about how money would be distributed to deliver care home requirements under the DES, Mr Sparke said: ‘It’s partly an unresolved question at this point. We understand that there are potentially significant disparities between the number of care homes that might be in a particular patch for one PCN versus another.

'To some extent, that variation is already captured via adjustments that are made to GP funding formula to take into account care homes that are in the existing areas of practices.'

But he acknowledged these adjustments 'may not be enough' to tackle the disparities.  

He said: 'We’re already in conversation with [the BMA's] GP Committee about how we can help, perhaps using the investment and impact fund in other areas, to support PCNs where that ask is greater.

'We haven’t got a final view on that yet. It’s very much an issue that’s being raised and we know we need to address it.'

The network proposals, released by NHS England on 23 December, were subject to an open consultation that closed last week.

The plans attracted criticism when it was revealed GPs will have to carry out visits to care home patients 'at least' every fortnight from this September, among other activities. 

Dr Bola Owolabi, NHS England national specialty adviser for older people and integrated person-centred care, reassured GPs that they will not have to see all care home patients.

Instead, home rounds will be delivered 'collaboratively between the PCNs and the community providers', she stressed.

Speaking in the webinar, she said: 'There may be occasions where what is required is either a one-off intervention and again this would be predicted on the personalised care and support plan for people who have been identified by the care home staff.

'The intention is not that every single resident within a care home needs to be reviewed at a particular interval. We want [it] to be led very much by the care home staff and the multi-disciplinary team in identifying people who need to be reviewed.'

She added: 'We acknowledge that other members of the multi-disciplinary team, indeed advanced clinical practitioners, already do provide input from a home round point of view and we want to harness that and build on that.

'We recognised that there is a key role for GPs to provide as the experts in support of the multi-disciplinary team. So the intention is not that it has to be done by the GPs as sole practitioners, the intention is not that every care home resident requires review at every visit. It’s absolutely about a multi-disciplinary approach supported with the expertise of a GP.'

The RCGP has urged NHS England to restart the development of the PCN service specifications, after previously raising concerns on the controversial draft document. 

Meanwhile, a recent Pulse survey found that 80% of partners do not want their practice to sign the network DES contract if proposals go ahead.

Readers' comments (18)

  • You can pay all you want - there just and the GP's or Noctors out there to actually do this.
    It's not the economics - it is the staffing - stupid.

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  • They dont get it the workforce capacity is not there.As for goodwill they mined that one dry a long time ago. Un-doable mess that the new contract is.Chucking a little money at it will not alter this.Although chuck enough 2ps under a bus some GPs might sacrifice themselves.

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  • FFS, other commentators on this website have said their practice did do regular visits to Nursing Homes and found it to be a pointless useless exercise with no benefit to admissions, one even commented it resulted in the demise of his partnership.

    As an aside patients in Nursing Homes already have a service from (trained??)staff, what about the frail elderly still living at home under the radar!

    Also 100% agree with "fed-up" where are the staff to do this please??

    Suggest BMA and NHS E start again with what they actually have and can actually manage to provide with the same.

    The airy fairy bollocks can wait over delivering the basics

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  • The underlying problem is a huge amount of frail people in the community and nursing homes at risk of admission at any time. In my experience good quality nursing and social care helps more than lots of doctor visits whose main benefit is stopping pointless medications. Keeping frail people active, fed, hydrated and stimulated should be the goal which is something we cant achieve ourselves.

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  • Strip all the Specs out of the PCN DES - including extended hours - and make them all separate DESs, all funded with real not imaginary money. Make the PCN DES only about collaborative working.

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  • The point of a PCN is to develop new ways of enhancing care locally depending on the needs both medical and physical of your population.
    The BMA dont need to negotiate they need to reject this proscriptive change to the DES that only fulfils a tick box exercise in futility and in no way will enhance patient care. There is no evidence for the 5 areas so reject them.

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  • This should be removed from the spec completely otherwise hopefully none of us will sign up. There should be No discussion with NHSE re this at all.

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  • It’s uncanny how the whole spec has now become about care homes and NHSE want to focus on that
    What about the utter nonsensical plan of delivery for the other 4 streams
    We don’t want extra resource for extra work
    We want proper resource for the current crisis
    Put resource into core, wake up BMA and GPC

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  • Does Mr ‘Ali Sparke, NHS England deputy director for contracting and incentives’ really believe that ‘rolling a turd in glitter’ will make it more desirable?
    It’s Shirley Knott the First of April?

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  • currently £150 per year per patient, that would pay for one home visit per year - for 26 weeks thats £3900 per patient per year, considering that includes travelling costs, consult and writing up time, med review, referrals, checking notes etc etc i think that works about right.

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