Living Guide

Key message

Care home residents include some of our most vulnerable patients, and recent national evidence illustrates the devasting effect Covid-19 is having on care homes.

Contractual requirements

1. On 1 May 2020 NHS England sent a letter outlining a ‘Covid-19 Care Home Support Service’ which was to be delivered by general practice to support care homes during the pandemic, in advance of the Enhanced Health in Care Homes (EHCH) Service element of the PCN DES commencing October 2020.
2. NHSE subsequently published requirements to ‘Transition between the COVID-19 Care Home Support Service and the Enhanced Health in Care Homes Service in the PCN contract DES’. By 31 July 2020 PCNs were required to:
   • assign every care home to a single named PCN and
   • ensure a clinical lead with responsibility for these Enhanced Health in Care Homes service requirements was agreed for each of the PCN’s Aligned Care Homes.
3. The Enhanced health in Care Home (EHCH) Service element of the PCN DES, with its clinical requirements, began on 1 October 2020.
4. As of 1 October 2020, a PCN must:
   1. Deliver a weekly ‘home round’ for the PCN’s Patients who are living in the PCN’s Aligned Care Home(s).
   2. Using the MDT arrangements, develop and refresh as required a personalised care and support plan with the PCN’s Patients who are resident in the PCN’s Aligned Care Home(s).
   3. Identify and/or engage in locally organised shared learning opportunities as appropriate and as capacity allows; and
   4. Support with a patient’s discharge from hospital and transfers of care between settings, including giving due regard to NICE Guideline 27.
5. Please note that the clinical lead has responsibility for oversight of the Enhanced Health in Care Homes service component of the PCN DES. The clinical lead is not medically responsible and accountable for the day-to-day care of individual care home residents which remains with the registered GP.Please see the PCN Contract DES specification for full details, noting that there were amendments published on 17 September 2020. These amendments include a change to the requirement for the EHCH clinical lead; it states:”The amended DES has changed the requirement for the clinical lead under the Enhanced Health in Care Homes service to note that – by exception – the clinical lead may be a non-GP clinician with appropriate experience of working with care homes, provided this is agreed by the practices in the PCN, the CCG and the relevant community provider.”

   For more information on the background to this and wider considerations on care home service see our Covid-19 and care homes guidance.

Guidance

1. The British Geriatrics Society has published a good practice guide on managing the Covid-19 pandemic in care homes for older people (published on 25 March 2020, updated 14 April 2020). This covers nine key areas in the care of residents, some of which replicate previous recommendations regarding advanced care plans, supportive treatments such as care home based oxygen therapy, and importantly multi-professional working, but also describes identifying Covid-19, where there may be differing presentations in the elderly, isolating residents, family visiting and decisions about escalation of care to hospital and end of life care.
2. The Framework for Enhanced Health in Care Homes (March 2020) outlines what needs to be in place for residents to benefit from the best model of care and support, working collaboratively and across boundaries. The Framework states that this supports the minimum service required, and that “CCGs should continue to develop and separately commission, as required, services that go further than the minimum national requirements in order to implement a mature EHCH service and must consider maintaining such enhanced services where they already exist“.
3. A ‘Novel coronavirus (Covid-19) standard operating procedure: running a medicines re-use scheme in a care home or hospice setting’ was published by NHSE and DHSC in April 2020. Due to the current unprecedented impact of Covid-19, the Department of Health and Social Care (DHSC) and NHS England and Improvement are recommending a relaxation of previous recommendations and the NICE recommended good practice guidance to accommodate re-use of medicines, under very specific circumstances and only in a crisis situation as outlined. NICE has previously produced guidance on medicine management in care homes.
4. Page 12 of the London Primary Care and Community Respiratory Resource Pack gives guidance on the management of suspected Covid-19 infections in care homes for use by care home staff.
5. ‘Admission and care of residents in a care home during Covid-19’ provides guidance to care homes, local health protection teams, local authorities, clinical commissioning groups (CCGs) and registered providers of accommodation for people who need personal or nursing care.