Agenda item

To receive a report from Leicester City Clinical Commissioning Group on a proposal to establish a new multi-disciplinary primary care service care home patients.

Sue Lock, Managing Director, Leicester City Clinical Commissioning Group (CCG) submitted a report on a proposal to establish a new multi-disciplinary primary care service for care home patients.

The CCG was currently undertaking work to determine the optimum model of care for residents of care homes within the city boundary. Patients in care homes were often the most medically complex and frail within the community.  They represented a complex interface between many different agencies such as primary care, acute care, community care, mental health, palliative care and statutory services. This often resulted in unnecessary admissions to hospital, lack of co-ordinated care and gaps in service provision. In all there were twenty five external services that have an input into care homes but currently these were not well integrated with primary care services. The CCG was working on a proposal to establish a new multi-disciplinary primary care service to provide targeted and specialist input into the care of this cohort of patients.

It was noted that there were approximately 2,260 people living in 107 care homes in the City.  Whilst this represented approximately 1.2% of the city’s population they accounted for 8% of acute admission to hospitals.  Some GP practices had no patients in care homes and others had in excess of 200.  This could lead to disproportionate effect upon a GP practice where residents in care homes could account for 2% of the patient list but account for 50% of patient visits. 

The current care model had a tendency to provide reactive care and the multi-disciplinary approach was aimed at ensuring:-

·         care for the patient was better co-ordinated

·         there was a continuity of care for the patient

·         more specialist support leading to enhancements in care

·         more end of life patients being able to die in their normal place of residence

·         the need to be admitted to hospital unnecessarily was minimised

The new model would need to maintain patient choice and it would need to enhance the current primary care services and not destabilise them.

Engagement had taken place with care home patients and care home managers and both were very supportive of developing more joined up services for this cohort of patients.  The exact form of the new service was currently under consideration and would be subject to a Business Case approval by Leicester City Clinical Commissioning Group’s Governing Body either late 2015 or within the first quarter of 2016.

Members of the Board made the following comments:-

a)         Extra care provision should also be taken into account as people often preferred to take this option in preference to living in a care home.

b)         It should be recognised that people’s health can deteriorate whilst living in their own homes and there should not be a two tier system of care when people were not living in care.

c)         The new model should not be solely based around GPs providing care as models elsewhere in the country had shown that some patients felt more comfortable talking to nurses rather than GPs about their care. 

In response to Members’ questions it was noted that:-

a)         The new model of care should be able to be extended to incorporate the extra care provision and this would be considered when the options for the new care model were discussed.

b)         It was recognised that patients preferred to retain their own GP but some GPs were unable to provide sufficient dedicated time for all care patients in view of their other patient commitments.  The best solution was a formula where the patient received the best care package from various sources and was also able to retain a relationship with their own GP.    

RESOLVED:

1)         That the report on the Care Homes Primary Care Service Project be received, progress be noted and that the Board’s comments be considered as the care model is developed.

2)         That the Council’s Adult Care Scrutiny Commission should also be apprised of the options and asked to provide a view on the preferred model of care.