Dr Mark Spencer, clinical director of Fleetwood PCN and co-chair of the NHS Confederation’s PCN Network, discusses how PCNs should approach the enhanced health in care homes specification.
As of last week, we have a responsibility to deliver the care home specification. In strictly contractual terms, this contract is between NHS England and Improvement and clusters of GP Practices, otherwise known as primary care networks (PCNs).
However, PCNs cannot deliver the specification in isolation. In fact, even trying to do so goes against what PCNs are really all about.
The framework for enhanced health in care homes requires collaborative working to move away from traditional reactive models of care delivery towards proactive care centred on the needs of individual residents. To get this up and running will take strong relationships – and realism about what can be achieved now versus what we can build towards.
Delivery of primary care across a community requires integrated working across all providers in that place, and that cannot be contracted for within any sort of DES. Much of what’s within the care home specification sits outside of what groups of GP Practices can deliver.
It is therefore essential that clinical directors and other PCN leaders reach out to the multitude of individual provider organisations across their patch and prioritise how support and input is co-ordinated, recognising the limitations on everyone’s capacity.
It’s also essential to work with commissioners, including both NHS and local authority, to identify gaps in service provision, alongside the development of plans to see those gaps filled.
There are some key requirements within the specification that amply demonstrate the importance of this.
For example, a weekly multi-disciplinary team ‘home round’ to provide expert advice and care for those with the most complex needs. How difficult is that? A district nurse, GP or senior nurse from each individual GP Practice, clinical pharmacist, occupational therapist, heart failure community matron, respiratory community matron, mental health practitioner including dementia management expertise, wound care specialist, end of life input, social care, nutritionist, and so on and so forth, for a couple of hours every week, with everyone having access to the clinical record. Doable in a meaningful way that adds value to patient care?
Not to mention ‘workforce development, including the training and development for social care provider staff’, as well as oral health and dental support to care home residents.
‘Everything starts with relationship building’
The ambition with this specification is huge. The ability of PCNs acting in isolation to deliver it is tiny. So, lets concentrate on what we can do, while working with commissioners on what else is needed.
General practice input into the weekly ‘home round’ is essential. Practices really need to commit to this and be responsive to the ask for input coming from the PCN care home clinical lead. Input from the PCN clinical pharmacist is also a key component and I believe that their time should be prioritised to give them capacity to do this.
Co-ordination with district nursing, out of hours and end of life services is also key but is very likely to be ‘business as usual’ for most practices and PCNs.
One very interesting area is the development of digital services in care homes and this could be where progress may be the fastest. The use of video consultations is now well embedded within ‘normal’ practice – and it’s likely that this continues to expand in use in the care home sector.
Remote monitoring, for both acute care and routine care will also become normal practice in the not too distant future. The ability of technology to remotely upload data like blood pressure readings, pulse oximetry and temperature directly into patient records using bluetooth technology is already in existence. This could then be coupled with co-ordinated 24/7 care across ‘in-hours’ and ‘out-of-hours’ services, with clinicians being alerted to abnormal readings. We then have the ability to intervene early, around the clock, to prevent deterioration and potential hospital admission.
In short, we need to be realistic about what can be achieved in the here and now, while working with commissioners on what gaps need filling, and embracing a future ambition that will certainly involve the digital revolution.
All of this must be done though without forgetting that everything starts with relationship building between one human being and another human being. Once that is in place then the rest of it becomes that little bit less difficult.