East Kent Coastal Teaching Primary Care Trust
Local Enhanced Service for Care Home (Nursing) Patients
Service Level Agreement
1. Finance Details
2. Care Homes (Nursing) to be covered by the agreement
3. Signature Sheet
5. Service aims
The amount of care needed is greatest when a patient first enters a Home,
and consequently a one-off fee off is payable for each patient admission.
Event Single payment
On admission to home £80
The amount of time and care that a person needs from his/her GP varies, and
is reflected in the pricing below:
Category of patient Per year
High care needs £300
Basic care needs £150
Elderly Mental Illness (EMI) £200
A “High Care Needs” patient is defined as one regularly requiring
unscheduled care once or more times per week. Please note that these are
prices per patient, not per bed.
Where a GP has successfully completed the Diploma in Elderly Care or in
Palliative Care, a supplement of £500 will be paid.
Claims should be made on the enhanced service monitoring sheet and should
reflect patient numbers as at the end of the claim period.
This LES is time-limited to 12 months from 1 April 2006.
PAYMENT WILL ONLY BE MADE UPON RECEIPT OF PRACTICE
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Care Homes (Nursing) to be covered by the agreement
Please indicate below the homes and the approximate numbers of patients for whom you propose to provide this service.
You are advised to consult with the PCT, neighbouring GP practices, home managers and community pharmacists in order to
reach a mutually agreeable position.
If your practice already has an agreement to provide additional services to a home, please indicate this in the right-most column.
Home Approximate no. of patients to be cared for Designated GP Existing agreement
High care Basic care EMI (please tick)
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Diplomas qualifying for additional payments
Please show below the doctors who hold a Diploma in Elderly Care or in
Palliative Care and provide copies of the certificates.
GP Diploma (title, date, awarding body)
This document constitutes the agreement between the practice and the PCT
in regards to this local enhanced service.
Signature on behalf of the Practice:
Signature Name Date
Signature on behalf of the PCT:
Signature Name Date
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An increase in the capacity of Care Homes (Nursing) within the PCT region
has provided the opportunity to develop a Local Enhanced Service to support
When a new patient registers with a practice for nGMS services, the patient is
invited to attend for a new registration check. This usually involves a basic
screen for common medical problems. A nominated member of the practice
usually carries out registration checks and any interventions are co-ordinated
by the primary health care team.
The type of assessment required by a patient admitted to a Care Home
(Nursing) includes a basic registration check, but also requires a more
detailed medical assessment. Patients’ multiple medications also require
careful reassessment of their appropriateness. An urgent report may need to
be to be requested from the patient’s previous GP. The majority of work takes
place in the six to eight weeks following admission.
This pattern of increased responsibility and direct impact on general
practitioner workload continues through out the period that the patient is
registered with the practice. Regular medication reviews are required as well
as a commitment to visiting the home on a routine basis.
In recognition of this increased commitment to the care of patients in such
homes, the PCT has defined such care as being a “non–core“ essential
service and it is therefore entitled to make payment through the provision of a
local enhanced service.
This agreement does not attempt to define the number and frequency of visits
that are required as these will vary.
This specification anticipates an integrated approach across community and
pharmacy services. It outlines a service that is above essential services.
The aim of this local enhanced service is to:
To ensure there is a framework in place to provide enhanced care for
Care Home (Nursing) residents in the PCT area.
To provide enhanced local medical services to Care Home (Nursing)
To improve patient access to medical services within the Care Home
To recognise the extra workload and complexity involved in providing
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This Local Enhanced Scheme has the following criteria:
1. Outline service specification
2. Visiting activity
3. Out of hours services
4. Summarised records
5. Community pharmacists
6. Support of PCT activities
7. Education and training
Criterion One: Outline service specification
The practice is to ensure:
A comprehensive assessment of all new patients to a home.
A six monthly assessment of residents (where life expectancy indicates
this to be appropriate).
Collaborative working with the other agencies involved (Nursing Home
staff, Community Pharmacy, District Nursing, Hospice, Hospital, Social
Regular, scheduled visits, commensurate with patient needs.
Criterion Two: Visiting activity
The GP will provide:
Full assessment of new admissions. This must take place as soon as
possible after admission. Best practice is within three working days.
Where possible, information should be requested in advance. A visiting
plan should be drawn up.
Regular visits. The appropriate frequency will vary depending on
Medication review. Patients should receive a regular, scheduled
medication review, at least every six months.
Patient review. Six monthly reviews of all patients should take place.
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Care plan. The GP will agree a care plan and risk assessment for each
resident, in consultation with the home.
Continuing Care. The PCT’s Continuing Care Liaison Nurse will liaise
on a regular basis with the GP so that the patients receiving continuing
care have their current medical status documented in their medical
records and appropriate assessment for possible change in funding is
resolved. The frequency of this liaison will depend upon the patient’s
classification and situation.
Care Home Nursing Staff. The GP should ensure that any instruction to
nursing staff is understood and that they are in a position to carry out
these instructions. E.g. in the case of venepuncture, that staff are
trained to take blood. If these instructions cannot be carried out then
the General Practitioner is responsible for making alternative
Items needed prior to a visit. The GP should agree local arrangements
for items that need to be completed prior to the visit, in order to allow
most efficient use of time. E.g. collection of basic benchmarks such as
Bartel Scores, blood chemistry results etc; completion of chronic
disease management guidelines; undertaking measurements of vital
signs by nursing staff.
Management meetings. The GP should have regular meetings with the
care home management to discuss issues relating to patient care. PCT
or Community Pharmacists should be invited when appropriate.
Criterion Three: Out of hours services
Out of hours services will be the responsibility of the PCT’s Out of Hours
Criterion Four: Summarised records
A summary of the patient’s health record should be kept at the Home so that it
is available to medical practitioners who may be called to see the patient,
such as partner, locum or Out of Hours service.
The GP or other health care professional from the practice will be responsible
for ensuring the up to date health records are maintained in the practice. This
may be a printed summary from the practice clinical computer system,
updated every three months or more often if appropriate.
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Criterion Five: Community pharmacists
There should be robust arrangements for the regular supply of the patient’s
medication to the home and a record of the medication prescribed. This must
cover both repeat and acute prescribing. Home nursing staff are responsible
for ensuring that there is a record of the supply of medication to the patient.
The pharmacy and Home must ensure that MARS1 sheets are kept up-to-
Criterion Six: Support of PCT activities
The GP will undertake to support the PCT in the following activities:
Research and development of integrated care pathways for chronic
The development of common data entry systems for chronic disease
Criterion Seven: Education and training
The GP will undertake to participate in PCT education and multi-professional
forums with a view to extending current knowledge of elderly care, sharing
good practice and raising awareness of changes in provision.
Criterion Eight: Monitoring
The designated GP may be asked to report on:
The register of patients cared for under this agreement.
Regular review meetings held with the care home management.
The period of time between admission and initial review.
Visits to each home.
Visits to each patient.
Medicine Administration Record Sheet
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