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GPs to do weekly care home rounds under new NHS England plan

GP practices around the country will be paired with care homes with the expectation of carrying out a weekly round, NHS England has said.

A report to the NHS England board meeting on a new ‘enhanced health in care homes (EHCH)’ model, published yesterday, says care home residents ‘are not having their needs properly assessed and addressed’.

It says there should be one-to-one mapping of GP practices to care homes, with each resident having a named GP, across the whole of England.

GP leaders are warning that there are not enough GPs to carry out this level of enhanced care, and it will remove the concept of patient choice.

NHS England say that six areas are currently piloting the model, and are ‘seeing early results’ of enhanced primary care support, including ‘a reduction in falls, prescribing costs, reduced ambulance conveyances and fewer avoidable admissions’.

National director of commissioning strategy Ian Dodge said NHS England intends to set out a plan for ‘national rollout’ of the ‘EHCH’ model later this year.

The framework published yesterday says: ‘Wherever possible, there should be one-to-one mapping of GP practices to care homes within an EHCH as this arrangement simplifies care delivery (e.g. through multidisciplinary and interagency working between primary care and care home teams).

‘This arrangement needs to respect patient choice. Each resident should have a named GP to ensure comprehensive assessment, problem identification and care planning.’

And under the plans, GPs have to carry out a weekly round in the care homes they cover.

The document says: ‘A weekly “home round” should be held in each care home. This proactive round is a cross between a hospital ward round and a home visit, and it is crucial for reviewing and planning a resident’s care.

‘Members of the team who participate in the “home round” are the resident’s GP, the care home team and other members of the local MDT such as nurse specialists and pharmacists.’ 

Speaking at the NHS England board meeting yesterday, Mr Dodge said: ”We see significant interest across the country in adopting this model and scope for… rapid national rollout… and so later this year we intend to set out plans for national rollout.’

But GPC clinical and prescribing lead Dr Andrew Green warned that pairing practices with a GP was not in line with the NHS commitment to patient choice.

He said: ‘The idea of having all the patients in one care home registered with one GP practice rides a coach and horses through the concept of patient choice, and could leave a patient without a functioning doctor/patient relationship.’

Dr Green also pointed out that there was not enough GPs to roll out this scheme across England.

He said: ‘The real difficulty here is providing the recourses required, not only in term of money but in terms of staff too. Our 11,000 patient practice has 10 care homes and we would need another partner to deliver this scheme, a partner who simply doesn’t exist, and the workforce implications of this scheme make the promised 5000 extra GPs look rather paltry.’

Asked how the rollout of the new model would be funded, NHS England told Pulse it will ‘set out further details on funding shortly’, but said it is likely to form part of the ‘sustainability and transformation plans’ (STPs) that are currently being drawn up around the country.

A spokesperson added: ‘Local areas will have discretion as to how to provide those services but it does outline some of the services that need to be commissioned and the benefits that can be achieved as a result.’

The news comes as in the past there has been calls for GPs to stop charging retainer fees for services provided in care homes and as one in five care homes claim to be overcharged by GP practices.

It also comes as the GPC is in talks with the Government about scrapping the current enhanced service for avoiding unplanned hospital admissions of frail patients from next year.

What are NHS England’s new care models?

NHS England’s new models for general practice – multispecialty community providers (MCPs) and primary and acute care systems (PACS) – will have budgets based on the population they cover, similarly to the GMS contract, but covering a wider range of services.

The idea is for the new providers to hold a time-limited contract (of up to 15 years) during which they are responsible for the health outcomes of their patient population, and they are paid based on this rather than specific activities they perform.

The main difference between an MCP and a PACS is that MCPs ‘integrates core primary care with out-of-hospital services, social care, and some secondary care services where this is appropriate’, while the PACS ‘expands on this arrangement to include acute and tertiary services where it is wanted and feasible’, NHS England says.

NHS England says that the EHCS model ‘provides care for a segment of an MCP’s or a PACS’s population: namely those people who are living in care homes or supported living environments or who are at high risk of losing their independence’.

It says this is likely to include patients at highest risk of unplanned hospital admission and those ‘with the highest needs, such as frail older people’. In all three models, NHS England’s idea is for GPs to work as part of a larger multidisciplinary team with other health and care staff such as consultants, pharmacists and social workers.

NHS England has been told by the Department of Health to ensure half of England’s population is covered by new models of general practice by 2020. NHS England, in turn, has delegated this work to CCGs, trusts and local authorities who are divided into ‘sustainability and transformation plan’ (STP) footprints.