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Health: Care Homes

Volume 752: debated on Tuesday 11 March 2014


Asked by

To ask Her Majesty’s Government whether they have any plans to abolish the practice of payment of retainer fees to general practitioners for providing services to care homes.

My Lords, my honourable friend the Minister of State for Care and Support has written to the chief inspector of general practice and to the chief inspector of adult social care to ask them to consider this issue. Let me be clear: GP practices should ensure that any services provided to care homes for which a retainer is charged are not those currently provided under their contract with NHS England. NHS England is responsible for ensuring that the terms of the GP contract are being met.

I thank the Minister for that reply, but does she agree that, since all patients in care homes are, as she says, entitled to NHS services anyway, to charge them for an enhanced service and then not provide it is actually fraudulent? Moreover, it causes a great many problems in the NHS as well. If an old person is not adequately treated in the care home, that often results in unnecessary admission to hospital through A&E, unnecessary distress for the older person and unnecessary cost for the NHS when they could have been treated simply and quickly in the care home had the GP been doing a proper job. Will the Government take further action on this?

The noble Baroness is right, and the Government have made clear their commitment to improving care for vulnerable old people. As I said in my Answer, any GPs who provide services should do so free of charge, and any money paid by care homes to practices should be for something over and above that. The sort of thing that we might be thinking of is assistance with training or possibly helping out with something like a health and safety audit, but certainly not basic NHS care.

My Lords, there is a huge disparity in the fees paid by care homes and a variation in the services that they receive from GPs. Given the evidence of arbitrary levels of retainer fees and variability in the definition of “enhanced services”, can my noble friend tell your Lordships’ House what the Government are doing to prevent what appears to be double-charging?

It certainly does appear to be double-charging, and the department is working with both CQC and NHS England to get to the bottom of it. Guidance is in the process of being written and disseminated.

Can the Minister inform us whether consideration is being given to the model of nursing home medicine as a distinct specialty, combining the best of general practice with the best of community geriatrics? This was developed in the Netherlands to provide nursing home medicine care and intermediate-level care, and it has been shown to drive up the standards of care available to those with multiple co-morbidities and frailty.

Certainly. I cannot give chapter and verse on the particular instances the noble Baroness outlines but we are more than aware that proper care in care homes actually helps to drive down inappropriate hospital admissions. Out-of-hospital care can also be applied. That is an enhanced service under the new GP contract.

My Lords, I refer noble Lords to my health interests. There appear to be two different issues from the work by Care England. First, some GPs are charging nursing homes for work that ought to be provided free at the point of use. Secondly, other GPs are calling services “enhanced services” when they are no more than the normal services that should be provided free of charge. Will the noble Baroness say a little more about what action should be taken? As this appears to be fraud, as my noble friend has stated, should this not be a matter for referral to the police?

In the first instance, rather than referring it to the police, NHS England needs to find out exactly the extent of what is going on. The whole business of enhanced services is slightly confused because under the new GP contract there are several enhanced services that would be appropriate within a care home which should not be paid for. Also, “enhanced services” is used as a generic term to imply some sort of value added. Maybe we need to think about how we use language to better differentiate.

My Lords, today I had a letter through the House of Lords system on contacting your Member, or whatever it is called, which was referred to me by some other Member of the House. It is about a 91 year-old dentist in a care home who knows that he needs dental care. He has been referred to the community service and told that he must wait 16 weeks for an appointment. Of course, that is very hard. What is the relationship? The National Health Service for services in the care homes should be not only medical but dental.

Dental services are provided by NHS England, and community dental services fall into that area. In the first instance, I would probably contact my local CCG and ask it to talk to the local NHS England on its patch.

My Lords, will the noble Baroness or one of her colleagues in the Department of Health arrange to meet Alex Neil, the Scottish Health Minister, to discuss the position there and what we can learn from each other?

In the world of care there is a lot to learn from everybody. There are probably regular conversations with NHS Scotland and NHS Wales. The noble Lord shakes his head. I will go back to the department and suggest that such a meeting might be a possibility.

My Lords, given that most people in care homes are either paying to be in the care home or the local authority is paying for it, will the Government consider making it a requirement that all care homes have to tell those who are funding it how much, if any, of the fee is as a result of so-called enhanced GP services?

Certainly none of the fees should be towards enhanced GP services. That is rather the point that the Question asked by the noble Baroness outlined. What needs to happen is that NHS England must look at it quite seriously to ensure that no GPs are sending a bill to any care home on their patch for delivering services they should be providing freely.