Skip to main content

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.
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.

Popular posts from this blog

Example ADHD Referral Letter

Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have

Dr Curran and Partners – Clinical Update 10 August 2023

1. Measles The UKHSA has warned that unless MMR vaccination rates improve, London could experience a large measles outbreak. Measles is potentially a very serious illness with important complications - but is preventable though vaccination.  Please ensure patients and their families are up to date with their vaccinations. Please also check the vaccine status of new patients - particular migrants - and enter details onto the medical record of any vaccines given elsewhere. https://www.gov.uk/government/news/london-at-risk-of-measles-outbreaks-with-modelling-estimating-tens-of-thousands-of-cases 2. Shingles vaccination The shingles vaccine programme is being expanded. From September, GP practices will offer: - Those aged 70-79, 1 dose of Zostavax or 2 doses of Shingrix - People aged 50+ with a weak immune system, 2 doses of Shingrix - Those turning 65 & 70, two doses of Shingrix vaccine. For further details, see https://www.gov.uk/government/publications/shingles-vacc

Why we need to put an end to the GANFYD culture in the UK

One of the causes of increased workload in general practice are the many requests that doctors get for letters, reports and forms from patients or from external organisations. It’s now so common that doctors have coined a term for it: GANFYD – Get A Note From Your Doctor.  It’s seems that large sections of society can’t function without these “letters from doctors”. Instead of using common sense or employing their own clinical advisers, external organisations make repeated requests to NHS doctors for letters which are often not at all needed. Often the worst offenders come from the public sector – e.g. universities who seem to look upon NHS general practice as a source of free occupational health advice for their students. Universities never – of course - offer to pay for this advice they get from NHS GPs. Instead, university requests will come with a mealy-mouthed statement that any fee is the responsibility of the student. Like doctors are going to impose heavy fees on impoverished s