General practice is not ‘equipped or supported’ to meet the needs of care homes residents, according to a new report by the British Geriatrics Society.
In a major report which heavily cited the findings of a Pulse investigation into care home funding, the British Geriatrics Society argued ‘no model of co-ordinated healthcare has been developed to meet the need of care home residents’, and that ‘traditional general practice in many areas does not appear equipped or supported to fill this void’.
However, a clear lead should come from the top, the authors said, and ‘the UK nations’ health departments should clarify NHS obligations for NHS care to care home residents’.
The report also highlighted concerns around the potentially ‘unlawful’ payment of retainers to GPs working in care homes, and GPs being double-paid for providing enhanced GMS services to care home residents.
‘Many GPs have been found to have a contract with care homes to charge a fee or retainer for their services at the home. These were maintained over and above the general medical services contracted for them by the NHS.’
‘When such costs are recouped in charges to residents, the funding council or the NHS, the GPs are in effect being paid twice for the same service,’ said the authors. ‘It is unlawful for local authorities or individuals to be charged for GMS.’
Research has found retainers paid to GP practices range from £900 to £24,000 per year, with an average of £7,000.
The report also pointed to LES agreements with GPs as a preferable alternative, including a LES in Sheffield that reversed a rising trend in emergency hospital admissions and saved £145,000 in its first year.
It recommended commissioners forge ‘clear and specific’ service agreements with GPs providing care to older people in care homes, and backed RCGP plans, reported last month, for the development of GPs with a specialist interest in care homes. It also recommended regular reviews and advanced care planning.
The BGS report authors interviewed 21 health professionals, including five GPSIs in older people’s care.
Lead author Dr Finbarr Martin, consultant physician at Guys and St Thomas’ Hospital, London, said that excellent quality care for residents of care homes was ‘the exception rather than the norm’.
‘Healthcare support to care homes has been a low priority for commissioners and planners. No one professional group or sector can be blamed and the challenge now is to change things for the better.’
Key areas for GPs working care homes
Determination of residents’healthcare goals, prior to or soon after admission, ‘through a full bio-psycho-social diagnostic assessment taking into account the resident’s preferences and culture’
Creation of advanced clinical plans based on agreed healthcare goals and incorporating decisions about end of life care
Planned regular reviews of residents in light of healthcare goals and clinical changes, including medication and weight loss with nutrition and hydration intake reviews
GPs seeking to identify people at risk of falls or doing preventative work
Systems of communication between the care home and GP
Access to community health services, including district nursing, specialist nursing and allied health professionals
Source:Quest for Quality: British Geriatrics Society Joint Working Party Inquiry into the Quality of Healthcare Support for Older People in Care homes: A Call for Leadership, Partnership and Quality Improvement (2011)