We have had this experience in Durham, and a tough one it is to resolve too.
Technically, the home are right, you aren't entitled to payments for GMS
services - defining "more than GMS" is the tricky bit.
Your only options are (1) to send a rocket to the management (unlikely to
work), (2) to institute call vetting and pursue a tough line on visits, or
(3) to deregister the patients.
The approach I have seen working is to combine the three. Write to say that
you cannot manage the workload, deregister about 25% of the patients, and
warn them that the remainder are on notice, and that you will be vetting
calls. Talk to the CHC before you do this!
This approach has worked for at least one practice in the North-East, but it
might be difficult to push it through without your partners' support.
I would warn everyone on the list that Patrick is not alone in having been
subjected to this sort of thing, and nursing homes frequently use payments
as an inducement, then withdraw them, usually when the home occupancy falls,
or there is a change in ownership/management. The practice concerned then
finds itself in the poo, having built up a high level of expectation of
service which is difficult to wind down. I do not advise practices to accept
payments (which are capable of being misinterpreted, and can add a spicy
twist to complaints) and where possible, make sure that you are not the only
practice with which the home registers patients. There is safety in numbers!
Andrew
Dr. Andrew N. Herd MRCGP [log in to unmask]
Family Physician, Medical Adviser to Durham Health Authority
Lecturer in Primary Care, Durham University
Medical Editor, Practice Computing
-----Original Message-----
From: Patrick Pearson <[log in to unmask]>
To: 'gp-uk' <[log in to unmask]>
Date: 10 February 1998 22:43
Subject: FW: Nursing homes
-----Original Message-----
From: Patrick Pearson [SMTP:[log in to unmask]]
Sent: 10 February 1998 22:30
To: 'gp-uk'
Subject: Nursing homes
About 8 years ago a new nursing home opened in our practice area and the
owner?matron begged us to take on her patients because the poor sucker that
was already doing the job refused to come out at night from miles away and
visit anyone who was " a bit chesty and we would like him/her checked out".
Against my better judgement my senior partner agreed to take them on when
she offered a "retainer" fee of £x per patient per quarter. Being the
junior partner it was democratically decided by everyone else that I should
take on the work.
They get a regular weekly visit, computerised repeat prescriptions with a
one day delivery service, visits on demand, regular reviews of patients and
nursing problems, advice on nutrition and hygiene, a 24 hour a day service,
annual flu and pneumovax service, visiting phlebotomy by our practice nurses
as well as ear syringing as the matron refuses to allow any of her staff to
do this job,
She had a row with the SP after he complained about yet another request for
an out of hours visit and she unilaterally refused to pay our retainer fee.
Since then she has steadfastly refused to pay up despite frequent requests
saying that we are not providing anything in excess of normal GMS services.
We have one of the highest ratios of nursing home beds in the area and
frankly I am pissed off with going there.
I realise that we cannot demand a "retainer fee" but I feel that the service
provided far exceeds what is understood by GMS . The bulk of the patients
are very old, frail, demented and decamped from local long stay psychiatric
hospitals which are now closing down.
What are other subscribers experiences of such situations??
Patrick
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