Covid-19: GPs have a fortnight to start organising weekly care home reviews, says NHSBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1827 (Published 05 May 2020) Cite this as: BMJ 2020;369:m1827
GPs will be required to give extra support to care homes, including a weekly review of patients, within a fortnight in the next phase of the covid-19 pandemic, NHS England has said.
Every care home should get a weekly clinical review of priority patients, assistance with producing personalised care and support plans for residents, and pharmacy and medication support, NHS England said. It said that reviews should be delivered remotely and by a multidisciplinary team where possible.
It said the urgency of the situation required it to take immediate action to ensure that all care homes received clinical support. It has asked clinical commissioning groups to oversee the service and for it to be delivered by general practices and community health teams.
The details followed a letter to NHS leaders on 29 April from NHS England chief executive Simon Stevens and chief operating officer Amanda Pritchard,1 which said that a new enhanced health service for care homes would be rolled out nationally in May 2020 to give more support to residents.
The letter raised fears among GP leaders that NHS England was seeking to accelerate the rollout of the new primary care networks directed enhanced service (DES), about which many had serious reservations before the covid-19 pandemic.2
Richard Vautrey, chair of the BMA’s General Practitioners Committee, said that the profession should have been consulted before the directive was issued. “We were incredibly disappointed to see in the letter from NHS England that it intends to bring forward the introduction of key elements of the care home specification without engaging with the profession and in the full knowledge of the serious concerns many in the profession have previously expressed about this earlier this year. We have told NHSE that this approach is unacceptable.”
In a follow-up letter on 1 May setting out details of what it expects from the service,3 NHS England said that it was not trying to roll out the DES five months early but was seeking to ensure that services that were are already running in parts of the country were available consistently to all care homes.
It said, “We are looking for all practices to take part, not just primary care networks (PCNs). However, it will be less burdensome for general practice, easier for community partners and better for care homes for this to be delivered at a PCN level as the default. The intention is that from 1st October, the model will be adapted to support the service specification already set out in the Network Contract Directed Enhanced Service.”
The 1 May letter also made it clear that NHS England would collect regular “sitrep” data from clinical commissioning groups from this week, to understand the support being provided to care homes and help determine “whether regulatory provisions are required” to enforce its directive.
It said that additional costs to practices that “cannot be met from their existing resources . . . may be eligible for reimbursement.”
Vautrey said that practices were doing all they could to provide care for their patients in care homes but needed “proper support, not more regulation and bureaucracy.”
He said that the focus should be on ensuring that care homes had sufficient personal protective equipment and covid-19 testing, that patients could be admitted to hospital when necessary, and that proper IT infrastructure was in place to support virtual consultations. “We appreciate that it is imperative to do all we can to help care home residents, as well as the staff,” he said.
Stevens and Pritchard’s letter also set out other requirements for primary care over the next six weeks, including proactively contacting all patients in the “shielding” cohort who were extremely vulnerable to covid-19. Practices must ensure that these patients knew how to access care and were receiving their medications, and must provide safe home visiting wherever clinically necessary, the letter said.
Practices are also advised to deliver as much routine and preventive work as is safe, including vaccinations and screening, and to make cancer, other urgent, and routine referrals to secondary care as normal.