For the last 12 months, I’ve been working with and supporting the development of a care homes project running across two Primary Care Networks. This innovative project has seen the development and collaboration between Frailty Nurse and GP specialists in the Elderly. It helped to connect the local GP practices with a large number of care homes (both residential and nursing). It’s been working really well and some might say it was a good timing for the increase in support in those care homes when COVID happened.
However, it is not the cases for many care homes when the Pandemic first hit the country in March this year.
In early March, to those of us who are working within the project, we were alarmed that frail and vulnerable patients were being hastily discharged to care homes from secondary care in efforts to free up capacity and prepare for the numbers of anticipated critically ill COVID patients. Residents were not being tested for Coronavirus prior to discharge, meaning nobody knew if they had the virus when they arrived in the care homes. The layout of some care homes also makes it difficult to isolate and socially distanced residents. On top of the challenges to prevent those with dementia from wandering means that once the virus is in a care home, containment is almost impossible.
Alongside the lack of PPE for care home staff, unclear guidance on the virus and management in care homes at the time, it became very apparent to the staff and residents that they had been abandoned. Come as no surprise, care home staff were very frightened, and it is not until the middle of April when the press bring the issue to light.
Soon after that, I was reading page 4 of the letter from the NHS England, announcing the second phase of NHS response to Covid-19. Specifically, there was a bullet point on the key elements of the Enhanced Health in Care Homes (EHCH) specification, claiming it would be brought forward from October 2020 to May 2020 with further details promised. A Letter to the primary and community providers, outlining the details of some particular elements were published on 1st May.
Essentially, practices and community providers were given a fortnight to implement the followings:
- A consistent weekly “check in” to review patients identified as a clinical priority for assessment and care
- Development and delivery of personalised care and support plans for care home residents
- Provision of pharmacy and medication support
For the majority of GP practices and Primary Care networks, much of this care is already being delivered to a similar extent. However, a care home is now defined as a “CQC-registered care home service, with or without nursing”. It means whilst the EHCH specification indicates its aim on frail and older people (it talks about care planning in terms of using the Comprehensive Geriatric Assessment and involvement of Geriatricians, for example), it also includes homes for such as those with mental illness, learning disabilities and substance misuse. The residents of these homes are often younger, and not all housebound. In the part of the country in which I’m working, we’ve been consulting with commissioners to define what this means for these homes, which largely have specialist input in place already.
Another hot topic is the matter of swabbing residents and care home staff for coronavirus, an example of a central announcement being made without any well-thought details. With the Health Protection Agency stepping back and leaving CCGs to work with Local Authorities for a solution, the journey has been frustrated and challenging. They have to overcome a range of problems, including arranging private testing with some providers, meeting the surging demand, identifying those who will take them. All when the services are already at their limit.
The silver lining to all those involved is that organisations have stepped up to take on the challenge as a team. I see that the links between CCG, the Local Authority, District Nursing and Palliative Care Services, and Primary Care have grown stronger. Communication has improved, relationships have strengthened. Everyone has become more collaborative, and appropriate support to care homes and residents are provided. I would hope that this collective effort will continue beyond the Pandemic and provide a sound platform for the development of Primary Care Networks and Integrated Care Systems.