This site is intended for health professionals only

At the heart of general practice since 1960

Field criticises GPs for charging 'retainers' for care home provision

The chief inspector of primary care has attacked GPs following claims that some practitioners are charging ‘retainer’ fees for treating patients in care homes.

Professor Steve Field told the CQC board meeting on Wednesday that he had talks with ministers about GPs ‘refusing to talk to patients from care homes unless they get a fee’ following newspaper reports.

However, doctors’ leaders pointed out that GPs were only charging extra to care homes for providing services ‘over and above’ what was expected of them as part of the GMS contract.

Professor Field told the CQC board that he was in discussions with ministers about the issue.

He said: ‘I am disturbed by some of the newspaper reports about GPs refusing to talk on patients from care home unless they get a fee, that is completely wrong and we will look into that when we start to do our inspections.’

The reports followed research by Care England, the biggest umbrella body for English care home providers, published last month that found that 30 of 34 care homes it surveyed were charged ‘retainer’ fees to guarantee GP care for their residents.

However, Dr Richard Vautrey GPC deputy chair hit out the claims, saying that GPs were only charging extra to care homes for extra services provided.

He said: ‘Some GPs for example provide a weekly ward round to care homes for which they charge a retainer to the care home which is used to backfill for the time that a particular doctors spends away from the practice.’

He accused care home providers of having a ‘vested interest’ in not paying such retainers and therefore driving up their profits further.

‘Many GPs have got concerns about the numbers and the experience of care home staff who are employing less experienced staff which means an extra workload on practices,’ he said.

‘Many care homes are looking more and more like elderly care wards but they are greatly understaffed.’

Dr Vautrey warned that the CQC’s own expectations on care home provision was creating a ‘ripple effect’.

‘The more they ask of care homes, the more impact this is having on GPs, so CQC needs to be careful of the ripple effect they are having,’ he warned.

Meanwhile, Professor Field said he was ‘shocked’ at some local area team’s apparent lack of knowledge about which bodies provide out-of-hours GP services in their area.

He said that the CQC had written to CCG and local area teams requesting information about which out-of-hours providers they were commissioning, but said he had only so far received responses from nine of the 25 LATs.

‘It is disappointing that when we ask for information it does not come back quickly and that is a learning point for all of us,’ he said.

Readers' comments (22)

  • Took Early Retirement

    One cannot comment specifically on the Prof, but many "academic" GPs, and College senior officers really couldn't do the ordinary job. Some cynics say that is why some of them become academics in the first place, just like some become "committee doctors" on the CCG boards- anything rather than do a full-time GP job.
    So, it comes as just a little but rich when people tell us to get on with looking after the massively high demand patients in NH's for a princely £67 a year. That insures my teeth with Denplan for a whole TWO MONTHS. You won't get pet insurance for your rabbit for that much.

    Unsuitable or offensive? Report this comment

  • PLEASE just give him his knighthood - at least then he might SHUT UP.
    It's so apparent he is his own no.1 fan !!'

    Unsuitable or offensive? Report this comment

  • What has he been doing if he does not understand
    what the fee is for!
    Arrangements for regular ward round like time spent
    On a regular pre planned basis.
    What else about how GPs work does he not know!

    Unsuitable or offensive? Report this comment

  • Don't worry.....the super-GPs specialising in elderly care will take over for free soon.

    Unsuitable or offensive? Report this comment

  • May I suggest that from October, every nursing home in the country register with the Prof's practice.

    Unsuitable or offensive? Report this comment

  • I think that it is shocking that some practising GPs spend their time doing other things than looking after their patients. While a GP is raking it in moonlighting at a nursing home, his regular registered 9non nursing-home) patients are not going to be able to see him/ her.

    What next? A GP who has his own patients might spend his time swanning around the country given unsolicited, unproven and over-politicised advice to other GPs whilst being paid by the public purse and making himself unavailable to his own patients!

    Unsuitable or offensive? Report this comment

  • Azeem Majeed

    The current funding mechanism for general practice does not reflect the needs of patients with complex health needs such as those patients living in care homes. 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. Some PCTs introduced local enhanced services for care home patients to recognise the significant input from GPs needed by care home residents. These have often been continued by CCGs. The extra funding from an appropriately funded LES is essential if care home patients are to receive the care they need.

    Unsuitable or offensive? Report this comment

  • Well it's very simple. Most patients who live in homes are mobile - ie they walk around the home, walk to the lunch room etc etc

    Such patients will need to be brought to the surgery (with a staff member if required - after all, higher rate DLA is often being claimed). This may require a taxi, or some other form of assisted travel (at the home's expense).

    If homes and Prof Field wants to stick to the letter of the GMS contract and allow nothing more than this, we can too.

    Unsuitable or offensive? Report this comment

  • I think it is a very good thing that some of these issues are being aired in public. They need to be discussed and a rational way forward for both the NHS and GPs needs to be found. Care homes clearly want ( and need?) more than is currently funded.
    However, it is not helpful for people like Field or NHSE staff who demonstrate time and again that they do not understand the issues involved to shoot their mouths off and criticise GPs publicly before they understand what is being done and why. Why of why doesn't he ( or they) investigate first, listen and then propose a sensible solution? Or is the agenda still to slag off GPs as much as possible in the press and be seen to deal with us as if we are naughty school children?

    Unsuitable or offensive? Report this comment

  • I just hope he has been mis-quoted, otherwise he is an out of touch............(fill in the space)

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say