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Funding for GP services for people living in care homes

The Chief Inspector of Primary Care, Dr Steve Field, has criticised GPs for charging ‘retainer’ fees for treating patients in care homes. Perhaps Dr Field is unaware that the current funding mechanism for general practice does not reflect the needs of patients with complex health problems such as those patients living in care homes? The current capitation-based payment is insufficient to fund the level of primary care support these patients need from primary care teams and should be supplemented by need-based funding. The GMS weighted capitation formula used to allocate resources to general practices is a blunt instrument and does not work well for the small groups of patients with complex health needs. For these groups of patients, needs-based funding mechanisms are more appropriate.

Patients living in care homes have complex health problems that require significant input from GPs and community staff, as well as skilled care from the nurses who work in care homes. Residents of care home are potentially high users of hospital care as well as having very high prescribing costs, and additional investment in primary care and community services can be highly cost-effective, as well as improving the care these patients receive and their quality of life. Some PCTs introduced local enhanced services (LES) for care home patients to recognise the significant input from GPs needed by care home residents. These schemes have often been continued by CCGs. The extra funding from an appropriately funded LES or other funding mechanisms is essential if patients living in care homes are to receive the level of support from the NHS they need.

Comments

Anonymous said…
From Prof Steve Field, the Pulse report was no a fair reflection of what I said in the CQC board meeting. I know that some PCTs did and Area Teams are looking at enhanced service payments to help GP who have to look after some care homes, these are locally negotiated above GMS, my point remains that this extra funding is above and beyond GMS. I fully understand the system, it is just that we have heard reports of GPs charging for what are GMS service and according to some national bodies representing care homes, GPs have even refused to register some patients in care home if they do not receive addition funds from the care home.
Azeem Majeed said…
This comment reinforces my argument that patient with complex health need - such as those living in care homes - are taken out of standard GMS and funded through a separate needs-based mechanism.

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