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GPs could face regulation to ensure all care homes receive weekly ward round



NHS England may bring in ‘regulatory provisions’ to ensure all care homes receive a virtual weekly ward round unless ‘coverage’ is achieved across the country.

New guidance on the service, which is being brought in as part of the NHS coronavirus effort to be delivered by GPs and community services, also said it should be ‘established as soon as possible, and within a fortnight at the latest in order to support residents as quickly as possible’.

With regards to funding, the document said GP practices ‘may be eligible for reimbursement’ if the work generates additional costs which ‘cannot be met from their existing resources’.

GP leaders warned that practices might be ‘coerced’ into providing care for free and called on CCGs to ‘trust’ them with the flexible delivery of care homes services.

It comes as GPs were left confused last week as to whether or not the new service formed part of the Primary Care Network (PCN) DES.

Initially, NHS England chief executive Simon Stevens said they would ‘bring forward from October to May 2020 the national roll-out of key elements of the primary and community health service-led Enhanced Health in Care Homes service‘.

However, NHS England medical director for primary care Dr Nikita Kanani later said that the service is not part of the DES for now but is only ‘clinical guidance’.

The BMA’s GP Committee told Pulse it had not been consulted and called on NHS England to reverse the ‘unacceptable’ plans.

Setting out the clinical service model, the new document said ‘CCGs – working with general practices, community health services providers and engaging LMCs – should take immediate steps to implement the following support for care home residents’.

It said this should include ‘a consistent, weekly “check in”, to review patients identified as a clinical priority for assessment and care’, which should ‘include’ but not be ‘limited’ to those with suspected or confirmed Covid-19.

It should also include ‘the use of remote monitoring of Covid-19 patients using pulse oximeters and other equipment (which may be supplied directly to care homes or eligible for practice reimbursement)’, the document said.

The other aspects of the service include personalised care and support plans as well as pharmacy and medication support.

NHS England said that ‘to deliver this support’ CCGs ‘should take immediate steps to support individual practices and community health services teams to organise themselves according to their local areas or networks’.

It said the service should be ‘delivered for all care homes’ that are registered with the CQC, ‘with or without nursing’.

‘This model should be established as soon as possible, and within a fortnight at the latest in order to support residents as quickly as possible,’ the document said.

It added that regulation may be used to ensure care homes receive the support.

The guidance said: ‘NHS England and NHS Improvement will collect regular “sitrep” data from CCGs, starting next week, to understand the support being provided to care homes and the coverage achieved across the country.

‘This will provide information on whether there are local issues which need to be addressed and whether regulatory provisions are required. We will also look to collect information from care homes on the impact this service is having.’

NHS England further said CCGs would manage the process of reimbursing service providers for their costs, but only where they could not be met from ‘existing resources’.

The guidance said: ‘Additional costs for general practices and community health services providers – which cannot be met from their existing resources – may be eligible for reimbursement.

‘A reimbursement mechanism for general practice will be established to help practices meet the additional costs of Covid-19 related activity which cannot be met from existing practice resources.

‘Reimbursement will be managed through CCGs, on the basis of national guidance.’

NHS England has previously said GPs should keep track of all Covid-related additional costs, which they will be able to claim back from a national Covid support fund – however, no detail about the fund has yet been forthcoming.

Doncaster LMC medical secretary Dr Dean Eggitt told Pulse that he is concerned practices are being ‘coerced’ into delivering services that are ‘quite clearly’ outside their contractual requirements for free.

He said: ‘If we’re not contracted to do it, then we’re not receiving resources to do it. If we’re not receiving resources to do it then how are we supposed to do it safely as well as everything else?

‘I desperately hope that Nikki and her colleagues that have written this letter are not expecting general practice to do this work without resources, because as it looks at the moment, that’s exactly what they’re expecting.’

He added: ‘I’m slightly cautious that the letter has been written to coerce people – to make them feel as though unless they’re doing it, they’re letting people in care homes down and they’re not providing care that they should be providing.

‘It may be that it is written in a cleverly-worded way to play upon the emotions of practices.’

The mention of possible regulation is also a ‘threat’ to practices, Dr Eggitt added.

He said: ‘It’s their way of saying, “We do still really want to bring [the contract] in in October, but we want you to do the work now for free. And if you’re not going to do the work now for free, we will unilaterally impose it upon you so you have to do it for free.”‘

He added: ‘We should stop feeling guilty for asking to be paid to do our jobs.’

BMA GP committee chair Dr Richard Vautrey said: ‘It goes without saying that where practices have additional costs as a result of their Covid-19 response efforts, this will need funding.’

CCGs and local authorities must now ensure that local schemes resourcing additional support for care homes are rapidly commissioned and virtual consultations are enabled in care homes ‘to a greater extent’, he added.

Dr Vautrey said it is ‘encouraging’ that NHS England ‘appears to be listening’ to the BMA’s concerns but added that they must continue with this approach ‘rather than adopting a regulatory one’.