GPs demand funding for complex patients as care homes vow to stop retainer fees

Enhanced services funding must rise to help practices cope with the increasingly complex needs of many patients in care homes and the community, GP leaders have warned.

Care home: many patients have needs beyond GMS essential services says GPC
Care home: many patients have needs beyond GMS essential services says GPC

The warning came as an organisation representing care homes said practices in some areas had been refusing to engage with their residents unless they were paid a 'retainer' fee. Care England chief executive Professor Martin Green said homes would 'no longer pay retainers to GP practices'.

GPC chairman Dr Chaand Nagpaul told GPonline that he did not believe many practices were demanding fees to deliver essential services to patients in care homes. Retainer fees paid to practices by care homes were generally to 'provide advice to the home, develop systems and staff training' - work outside the standard GP contract, he said.

But Dr Nagpaul warned that because patients who would previously have been treated in hospital were increasingly being moved into the community, many patients seen by GPs had needs 'over and above esssential services as defined in the GP contract'.

GP essential services

Care homes should not have to pay GP practices to deliver essential services to their patients, Dr Nagpaul said. But CCGs needed to commission enhanced services to allow practices to deliver the full range of care these patients and others at home need.

'Most retainer fees paid to practices are for an agreement to provide extra services beyond the level in GP contract,' he said. 'If the issue is that essential services are not being provided, that is not in keeping in with the regulations. If that is the case it is not happening in a widespread manner.'

But Dr Nagpaul added: 'GPs are obliged to provide essential services for increasing numbers of patients in the community who have greater needs. Both in care homes and outside. Many areas have sensibly introduced enhanced services to help GPs meet those greater needs. Where patients need extra support that should be resourced thro enhanced services - CCGs should commission those services.'

Professor Green said: 'The position is sporadic and in some areas GPs are providing a really excellent primary care service to care homes and this is not paid extra for but part of normal GP provision, and in other areas, there are some very significant costs involved in engaging with the GP practices. In some areas. the only way to get a GP to register people in a care home is by paying a retainer.'

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