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Eye on the approaching storm of GP visits to care homes

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As the hurricane season gets into full swing in the Caribbean and the Southeastern United States – our thoughts are with all those affected – a storm is brewing here between NHS England and the GPC.

"Nothing new there," I hear you say. Maybe not, except this one started in 2013 when the government announced plans to impose a legal duty on doctors that would require GPs to begin regular visits to care homes. Earlier this year, GPs voted to stop looking after thousands of care home residents, citing lack of time and staff to provide adequate care.

Now NHS England have once again announced plans to steamroller GPs concerns and impose weekly rounds in care homes.

In this article we look at both sides of the argument, and discover just how difficult a predicament the situation is.

A new model for care in care homes

On 29th September, NHS England announced that GP practices will be paired with care homes and expected to provide a weekly round. This announcement was the response to a report about a new model of working, called 'Enhanced Health in Care Homes' (EHCH).

The new model expects one-to-one mapping of GP practices to care homes. The weekly round will be a cross between a hospital ward round and a home visit, intended to help review and plan a resident's care. The round will be conducted by the resident's GP, the care home team, and other members of the local MDT (which may include nurse specialists and pharmacists).

Why is EHCH needed?

In the red corner we have NHS England. They point out that:

  • The report says that care home residents "are not having their needs properly assessed and addressed".
  • The GPC is in discussions with the government about abandoning the current enhanced service for avoiding unplanned hospital admissions.
  • One in five care homes say they are overcharged by GP practices for services provided.
  • The EHCH model provides care for an 'at risk' segment of the population covered by its other models of care (PACS and MCPs – primary and acute care systems and multispecialty community providers).

What is wrong with EHCH?

In the blue corner we have GPs, represented by the GPC. It says that:

  • There are not enough GPs to provide the service.
  • It removes the concept of patient choice (because one care home will be paired with one GP practice).

How will EHCH be rolled out?

The plan for the rollout of EHCH will be set out later this year. Details of how it will be funded will be made public later this year, too, though the funding is likely to be part of the sustainability and transformation plans (STPs) that are currently being devised around the country.

In conclusion

When the arguments from both sides are laid out like this, it becomes obvious that GPs are not at odds with the need of care provision and GP cover in care homes. However, the GPC is quite rightly arguing the case for a primary care service that is already overstretched and underfunded.

There are almost 17,000 registered care homes in England, with around 300,000 residents. If each home were to be visited once per week, that totals around 880,000 visits per year. GPs estimate that an average visit would take one morning per week. There are then associated tasks to budget for: phone calls, unplanned admission reviews, dementia reviews, treatment escalation planning, and so on and so forth.

It's not hard to imagine that a GP practice that provides services to five to ten care homes under the EHCH model will require at least one extra GP. If not, its provision of services to existing patients is likely to suffer.

The questions that now need to be answered are: how will this be funded, and where will the practices find the extra doctors they need?

Until answers are forthcoming, EHCH appears to be an objective rather than a fully planned strategy.

eSupplies Medical is a trading name of Williams Medical Supplies Ltd, a DCC business