Care homes call practice of GPs charging fees to treat residents 'totally unacceptable'

Care England, the leading body for care home providers, has called the practice of GPs charging retainers to work with care homes “totally unacceptable”.

Care England, formed from a recent merger of English Community Care Association (ECCA) and National Care Association, has revealed that the practice is still rife after it carried out a survey last year.

The findings of the 2013 survey found GPs continue to charge retainer fees for basic services.

Out of the 34 care homes that responded, 30 pay a retainer to secure the services of a GP practice. Of these 30, only two defined the service that they receive from their local practice as being enhanced. One care provider surveyed stated that the retainer fees their homes pay for a basic service fall between £1,000 and £2,400 per month.

English Community Care Association highlighted the existence of this widespread practice back in 2008 when it carried out a survey showing that one of the central principles underlying the NHS, namely that health care should be free at the point of delivery, was not necessarily true for residents of care homes.

Professor Martin Green, chief executive of Care England, said: “Some care homes are paying thousands of pounds for a basic health service, which citizens have always been told would be free, and we have discovered one GP who has insisted the care home use his surgery pharmacy, as a condition of attending to care home residents.

“Charging care home residents for healthcare, is ageist and totally unacceptable, and we call upon the Government, Clinical Commissioning Groups and the Care Quality Commission, to put a stop to it immediately.”

However GPs have defended the practice of charging care homes a fee. Dr Richard Vautrey, deputy chair of the British Medical Association's (BMA) General Practitioners Committee, said: “This research highlights a practice that only affects a small number of care homes and very small number of general practices.

“Where it does happen it is in recognition for additional work practices provided to large nursing homes, over and above routine care that is provided to all patients, such as extra ward rounds or daily visits. This additional service provided by practices needs resourcing to enable them to expand their staff so as to avoid unduly impacting on the quality of care provided to all their other registered patients.

“Care homes have faced cuts to their resources and in some cases this has lead to change in nursing home staff which puts additional pressures on local GPs.

He added: “GPs have a responsibility to provide care for all their patients and that includes those living in care homes. The vast majority of practices don’t receive fees and the vast majority of care homes don’t pay for additional services. And it is important to remember that in those instances where extra workload is recognised it is not the patient who is charged the fee.”

According to the research, many of the care homes surveyed worry that if they did not pay this money, the implications would be too disastrous to consider. As one care provider put it: ‘Yes [the fee] is essential, the repercussions might be that our very frail and vulnerable residents would not get the care that they routinely and urgently require’. In addition, some care homes believe that even paying such a fee guarantees no improvement in the quality of service provided.

At this time when local authorities’ budgets are being cut to the extent that they can no longer afford to pay care providers the true cost of care, Care England believes it is unfair to ask these providers to pay a retainer fee for services that their residents should receive free of charge.

Care England has therefore made a number of recommendations, most importantly that the GP contract for 2015/16 should clearly state which services GPs have a right to charge for and which should be free at the point of delivery, and that the Care Quality Commission prioritise a way of monitoring GPs in this regard. It also calls for the NHS to review what constitutes an ‘enhanced service’ offered by a GP to a care home on an annual basis, and give guidance on how a fair fee for those services should be calculated.

Last year the Care Quality Commission called for GPs to improve support for patients in care homes to cut inappropriate hospital admissions.

Under new proposals by the Government, GPs are likely to become named clinicians responsible for the care of vulnerable older adults, as part of its plan to alleviate pressure on A&E.

This will mean every older person with complex health needs will have a named clinician responsible for their care.