Commissioning for Care Homes: A Low Priority for PCTs?
EMBARGOED UNTIL 00.01 HOURS WEDNESDAY 2 DECEMBER 2009
Commissioning for Care Homes: A Low Priority for PCTs?
Research published today in Clinical Medicine, the Journal of the Royal College of Physicians, highlights that care home residents are missing out on access to vital specialist care as hospital doctors are stretched too thinly and Primary Care Trusts (PCTs) fail to commission additional services. Two national surveys of PCTs and doctors who specialise in the care of older people found that only 16% of geriatric medicine departments across England allocated time for care home work, which equates to just 1% of total consultant geriatrician time.
Figures show that in 2007 over 350,000 people aged 65+ were living in care homes in England, many of whom had ongoing and complex needs, including dementia, stroke, Parkinsonism, and mobility problems. Although General Practitioners (GPs) have primary responsibility for the medical care of care home residents, less than 40% of GPs have had specialist training in the health and social care needs of older people. Despite this, less than one in five (18%) PCTs funded the involvement of a specialist geriatrician in care homes in their area.
Responding to the surveys, 73% of geriatric medicine departments said they would favour greater involvement in care homes, increasing to 85% if more resources were to be made available. 57% of PCTs also reported that geriatricians’ involvement in care homes was important. However, nearly half (45%) of geriatric departments reported local PCT initiatives to support care homes which were designed and delivered without their knowledge and input.
Despite comprehensive evidence showing the benefit of specialist assessment prior to admission, 68% of geriatric medicine departments reported no involvement in admission to residential care homes from the community (a corresponding 64% for nursing home admissions). It is these people, who are going into a care home straight from home, who are most likely to miss out on treatment for reversible aspects of any disability.
Further findings include:
- 75% of departments knew of a committee or panel assessing patients’ needs on admission to a care home in their area, but only 10% of these included a consultant geriatrician.
- 84% of PCTS indicated that they had a standardised comprehensive assessment for people being admitted to care homes, but few had a mandatory requirement for an old age psychiatrist (17%) or a geriatrician (16%) to be involved in completing the assessment.
- Only 14% of geriatric medicine departments reported a regular forum by which GPs and nurses could discuss challenging patients, a low rate confirmed by PCTs (11%).
Dr Eileen Burns, British Geriatrics Society Care Home Lead said: “GPs, community matrons and other allied health professionals play a vital role in supporting care homes and ensuring that residents receive timely and appropriate healthcare. However, we are concerned that our expertise in assessment of frail older people, who may be living with several chronic conditions, is not being drawn upon to support the care of these complex patients. This includes, involving us in pre-admissions assessments; allowing us to provide advice to GPs, nurses and care home managers; and letting us assist with the design of appropriate services which would be of maximum benefit to this group of older people. This could help prevent unnecessary future hospital admissions and, in some cases, may avoid or delay a move into a care home.”
Dr Finbarr Martin, consultant geriatrician and lead researcher, said: “Our research indicates that care home residents may not have sufficient access to specialist services to meet their complex healthcare needs. More appropriate commissioning is needed to improve care home residents’ access to appropriate healthcare. Support from the Department of Health for this approach by PCT commissioners could improve the clinical provision received by older people who are entitled to NHS continuing healthcare.”
Dr Mike Cheshire, Clinical Vice President of the Royal College of Physicians, said: “The results of this survey support calls for more geriatricians to be based in the community, overseeing and coordinating care to prevent unnecessary admissions to hospital. As numbers of older people rise, keeping people healthy and out of hospital will not only benefit them, but also be a more efficient way of using resources.”
For more information and a copy of the report contact Iona-Jane Harris on 020 7608 8573 or
or Zoe Horwich on 020 3075 1354 or
Notes to Editors
1. The research was conducted by geriatricians at Guy’s and St Thomas’ NHS Foundation Trust and was funded by a grant from the British Geriatrics Society. Complementary surveys for PCTs and geriatric medicine departments were completed by 109 of 167 geriatric departments (65%) and 141 of 303 (47%) of PCTs across England.
2. The Department of Health National Framework for NHS continuing healthcare and NHS-funded nursing care was published in July 2009 and can be accessed via this link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyandGuidance/DH_103162
3. The Royal College of Physicians of London provides a huge range of services to its 20,000 Members and Fellows and other medical professionals. These include delivering examinations, training courses, continuous professional development and conferences; undertaking clinical audits; publishing newsletters, guidelines and books through to maintaining the College's historical collections. It also leads medical debate, and lobbies and advises government and other decision-makers on behalf of its members.
4. The British Geriatrics Society (BGS) www.bgs.org.uk
<http://www.bgs.org.uk> is a membership association of doctors, nurses, therapists, scientists and others with a particular interest in the care of the frail older person and in promoting better health in old age.