NHS England and the CQC are investigating claims that GPs are ‘double-charging’ for services provided to care homes, an allegation GP leaders have described as ‘nonsense’.
Baroness Jolly, who is a Liberal Democrat health whip in the House of Lords, said that the Department of Health is working with the CQC and NHS England to produce guidance on the ‘disparity’ between the fees charged by GPs to care homes and the services provided.
In a parliamentary debate yesterday (Tuesday), Lords said that GPs are engaging in ‘fraud’ by charging for work that ‘ought to be provided for free’.
However, GP leaders have said there is no double charge at all, and that the services being discussed were ‘over and above’ contract requirements.
The chief inspector of general practice, Dr Steve Field, had previously attacked GPs over claims that they were ‘refusing to talk to patients from care homes without receiving a fee’.
The Lords debate was in response to Dr Field’s claims. Liberal Democrat peer, Baroness Brinton asserted that there was a disparity between care home fees and the GP services they received, and asked what the Government was doing to prevent this ‘double charging’.
Baroness Jolly replied: ‘It certainly does appear to be double charging, and the department is working with both CQC and NHS England to get to the bottom of it. Guidance is in the process of being written and disseminated.’
A Labour peer, Lord Hunt of Kings Heath argued that some GPs were charging for work that ‘ought to be provided free’ and that some GPs were labelling standard care as enhanced services.
He said: ‘Will the noble Baroness say a little more about what action should be taken? As this appears to be fraud… should this not be a matter for referral to the police?’
Baroness Jolly answered: ‘In the first instance, rather than referring it to the police, NHS England needs to find out exactly the extent of what is going on. The whole business of enhanced services is slightly confused because under the new GP contract there are several enhanced services that would be appropriate within a care home which should not be paid for.’
But GPC deputy chair Dr Richard Vautrey explained that enhanced services were only those that went beyond standard care, such as providing a ‘ward-round type of visit’ – taking a whole afternoon to proactively assess every patients’ care – instead of making visits at a patient’s request.
He added: ‘Now that means the practice has to resource that, if the GP is spending a whole afternoon at the care home then somebody has to be seeing a GP back at the practice, and that means employing a locum or a salaried GP or expending another partner’s time, and that takes resource.’
‘That’s what the resources is used for, it’s used to maintain resource back in the practice. So if you hear that practices are “making money” out of this, it’s just about practices covering their costs.’
He added: ‘It’s nonsense […] A very tiny number still receive [retainers], but those practices that do so at the request of the care home and provide an additional level of service that’s over and above standard GMS practice.’
‘There’s no double charge at all, and it’s excuse making by certain people trying to blame GPs for what – actually – is a much bigger issue: the need to properly resource care for patients in the community, and the lack of resource for people, not just in nursing homes or residential homes, but in their own homes.’
Dr Peter Davies, a member of the RCGP Council, said these enhanced services were in line with Government policy.
He said: ‘It’s actually on a par with what they’re proposing with the named clinician for over 75s; basically saying old and vulnerable people need systematic and organised care, and not just seeing every so often when they get a chest infection.’
NHS England explained that, working through their area teams, they were responsible for ensuring practices dont breach the terms of their contract and take actions where breaches are identified.
A spokesperson told Pulse: ‘Except in certain prescribed circumstances, regulations prohibit a GP from charging patients a fee for services that should be provided under the GP contract. The regulations also prohibit indirectly charging patients, for instance by requesting fees from a care home.’
‘It is a matter between a GP practice and a care home if they agree to enter into a private arrangement to provide services that fall outside those provided through the GP contract.’