Nothing has gone well when it comes to care homes in this pandemic.  Care home staff trying to look after an extremely vulnerable group of patients have been left on their own, without access to the support, resources or equipment they need.  Figures from the Office for National Statistics show that between 10 and 24 April, there were 4,343 recorded deaths from Covid-19 in residential care homes.  The number of deaths in care homes is rising at a higher rate than hospitals.  Frustration with the lack of support has grown, not just among staff and relatives but more widely across the country.

It is probably in response to this frustration that Simon Stevens announced in his letter to the NHS on Wednesday 29 April, “To further support care homes, the NHS will bring forward a package of support to care homes drawing on key components of the Enhanced Care in Care Homes service and delivered as a collaboration between community and general practice teams. This should include a weekly virtual ‘care home round’ of residents needing clinical support.”

Now anyone paying attention to the events surrounding the 2020/21 PCN DES will have been able to predict the reaction from general practice.  One of the most contentious issues surrounding this year’s PCN DES was the specification that related to enhanced care in care homes with the workload implications it contained for GPs.  Eventually a care home ‘premium’ of £120 per bed was agreed, with a trimmed down version of the specification to be implemented from October 1^st, that allowed for “appropriate and consistent medical input from a GP or geriatrician, with the frequency and form of this input determined on the basis of clinical judgement” (as opposed to mandatory GP participation in weekly ward rounds at each home).

But this was a fragile compromise at best, and so it was no surprise that the new announcement attracted a vehement response from the GPC.  Chair Dr Richard Vautrey said the next day, “We were incredibly disappointed to see in the letter from NHS England yesterday that it intends to bring forward the introduction of key elements of the care home specification without engaging with the profession, and in the full knowledge of the serious concerns many in the profession have previously expressed about this earlier this year.  We have told NHS England and Improvement that this approach is unacceptable. The profession will be rightly dismayed that this element of the contract scheduled for October, which depended on an expanded workforce and additional resources, could be imposed without either being provided.”

Cue some backtracking from NHS England.  It turns out that anyone thinking that Simon Stevens letter was about bringing forward the DES specification was wildly mistaken.  In fact, as a letter from NHS England on the 1^st May clarified, it is rather a service that needs to be established “as part of the COVID-19 response”.  Of course it not the PCN DES specification, because, “We are looking for all practices to take part, not just Primary Care Networks (PCNs). However, it will be less burdensome for general practice, easier for community partners and better for care homes for this to be delivered at a PCN level as the default.”  What were we thinking?

But however we got here, we are where we are.  If we have learnt anything from coronavirus it is surely that care homes need to be tied much more closely into the health and social care system, and there is a  clear and pressing need right now to provide better support to care homes.  Such a need in fact that NHS England has outlined a two week deadline(!) for the new service to be put in place.

I know there are some places around the country that have tackled this in the past and have arrangements in place that effectively mean all the new requirements are already met.  There are, however, others where there are vast numbers of residential homes and no such arrangements in place.  The challenge in these areas cannot be underestimated.

Let’s hope the wider system puts the support and resources into general practice and PCNs that will be needed for an effective response to be mobilised.  And let’s hope that care homes start to get the support that has been so sadly lacking so far through this crisis.