A really significant amount of work has already taken place to establish the COVID-19 care home support service. In delivering this interim model, local systems have implemented core elements of the more comprehensive Enhanced Health in Care Homes (EHCH) service in the Network Contract Directed Enhanced Service (DES).
The EHCH service will be fully implemented, as described in the Network Contact DES and associated guidance, from 31 July 2020 (with the bulk of clinical requirements starting on 1 October 2020). This includes ensuring that every care home is assigned to a single named primary care network (PCN) by 31 July 2020, which is then responsible for delivering the service requirements. We will be seeking confirmation from clinical commissioning groups (CCGs) to confirm this arrangement is in place across the country.
Both the interim care home support service, and the EHCH service in the Network Contract DES contain a requirement to nominate a clinical lead who is responsible for ensuring that the service is delivered. In the EHCH service, it was stated that this position must be held by ‘a lead GP (or GPs)’. The interim arrangements for COVID-19 simply required a(ny) named clinician.
Although we expect that this role will continue to be held by a GP in the vast majority of cases, we know that some alternative models have been established through the COVID-19 response – for example where the position is held by another member of the practice team, or by staff in community trusts.
In order not to disrupt these emerging models, and to support the positive relationships developing between clinical leads and care homes, we will amend requirement 7.3.1 (d) in the Network Contract DES 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.
The PCN will remain responsible for nominating the clinical lead, and if the clinical lead is from a partner organisation such as a community provider, the PCN still remains responsible for all aspects of the delivery of the EHCH service requirements in the DES. The clinical lead will support the establishment of multidisciplinary teams and weekly home rounds, and help to strengthen links between care homes and PCNs. The clinical lead is not medically responsible and accountable for the care of individual care home residents. The responsibility for the service delivery described in the DES lies with the PCN.
Training requirements for personalised care roles
We encourage PCNs to engage personalised care roles – social prescribing link workers, health and wellbeing coaches, and care coordinators – as these roles will be able to support the COVID-19 response through embedding personalised care approaches. We have a range of resources already available for social prescribing link workers. Whilst the Personalised Care Institute (PCI) is being established, the requirement in the DES for staff in personalised care roles to be enrolled, undertaking or qualified from training accredited by the Personalised Care Institute does not apply and, in the interim, we will provide additional training resources for the health and wellbeing coach and care coordinator. We expect PCNs to use their professional judgement to ensure that all staff are appropriately trained. Once the PCI has established accredited training courses, the requirement set out in the DES will apply to new personalised care staff.
How these changes will be applied
The formal amendment to the DES is likely to take place later this year, and details of the process for this will be confirmed shortly. In the interim, we give notice that these flexibilities will be applied operationally, and no contract action would be taken against any PCN delivering the service or personalised care training requirements.
As per the interim care homes service, the homes in scope for the EHCH requirements in the DES are CQC-registered care home services, with or without nursing. In exceptional cases where a care provider has been identified as a CQC-registered care home, but the care provider agrees that it:
- does not perform this function substantively, and
- should not therefore be subject to the EHCH requirements set out in the DES, the CCG may agree not to allocate that provider to a PCN.
In case of dispute, the CCG should seek advice from the local authority. The CCG should ensure it maintains clear evidence of this agreement.
All other elements of the EHCH service remain as set out in the Network Contract DES.
PCNs – with support from commissioners – should take account of the specific requirements in the DES and the associated guidance as they transition from current models to delivery of this service.
Thank you for all of your efforts in providing clinical support and leadership for care homes, their staff and their residents during the COVID-19 pandemic.