Contentious NHS scheme to bolster care homes brought forward

In a letter to local leaders, NHS England and NHS Improvement said they expect an increase in demand for covid-19 “aftercare and support” in the community.

“Given the scale of the challenges they face” the NHS must continue providing “mutual aid with our colleagues in social care, including care homes”, wrote chief executive Sir Simon Stevens and chief operating officer Amanda Pritchard.

The NHS is therefore moving to an early rollout of several components of the “enhanced health in care homes service” in May. This was previously due to be launched by primary care networks in October, as part of a push to encourage joint working between GPs, community services and social care.

The letter does not specify which parts of the service will start next month beyond the requirement it “should include a weekly virtual ‘care home round’ of residents needing clinical support”.

However, GPs have also told HSJ the fundamental change to services brought on by the response to the pandemic, including a huge increase in telephone and other remote consultations, means some GPs have been providing services in care homes that go beyond the requirements in the initial specification.

The enhanced care home service was a major part of the new primary care network contract for 2020-21, which was agreed by NHSE and the British Medical Association in February. The NHS has postponed almost all other additional service requirements on primary care, including those in the PCN specifications.

The care home service was a leading source of dissatisfaction from doctors during the PCN contract negotiations earlier this year.

The centre’s first draft of the PCN 2020-21 service requirements called for weekly care home visits by a GP or community geriatrician, which was seen as a significant additional workload for GPs without commensurate additional resources.

This was subsequently changed to weekly care home rounds by multidisciplinary clinicians for those residents most in need, with “appropriate and consistent medical input from a GP or geriatrician”.

The letter also set out several areas of mutual aid the NHS can provide to social care, including: covid-19 testing patients being discharged to care homes, with a system for homes to check the tests have been carried out; infection prevention training from councils and NHS commissioners; and opportunities for younger returnees and volunteers to support care homes.

Meanwhile, the letter also said GPs will need to “stratify and proactively contact their high-risk patients with ongoing care needs”. Particular attention will need to be paid to those on the NHS shielded patient list who are considered “extremely vulnerable to covid-19”.