22 January 2014

Care England, the umbrella body for English care providers formed from a merger of the National Care Association and English Community Care Association, has warned that GPs charging care homes retainer fees for NHS care for their residents is “unacceptable” and must end.

Care England’s 2013 survey revealed that the situation had not improved since a Health Select Committee (HSC) elder abuse report criticised the practice, nor since the body’s previous report of 2008 entitled Can We Afford the Doctor? and not since work has been carried out by the Social Care Institute of Excellence (SCIE), NHS England and Monitor to improve the situation.

In 2004, the HSC made the recommendation that “the practice of the payment of retainer fees is abolished”. The Department of Health (DH) announced in response: “Everyone who is eligible to receive NHS care is entitled to be registered with a GP if they so choose. This right applies equally to those who live in their own homes and those who live in sheltered accommodation or in care homes.”

Care England chief executive Professor Martin Green said: “Charging care home residents for healthcare is ageist and totally unacceptable, and we call upon the Government, clinical commissioning groups and the regulator to put a stop to it immediately.”

The report summary, The Practice of GPs Charging Retainers to Care Homes, said that 30 of 34 care homes surveyed were still being charged GP fees, one of which was paying £2400 a month. The report said many of the care homes surveyed expressed worries that if they did not pay this money, “the implications would be too disastrous to consider”. Providers that ran multiple homes told the survey that they found the services provided by charging GPs were just as good as those that were not requesting retainers, discrediting the suggestion that they were being charged for an “enhanced” service.

Professor Green added: “Some care homes are paying thousands of pounds for a basic health service, which citizens have always been told would be free, and we have discovered one GP who has insisted the care home use his surgery pharmacy, as a condition of attending to care home residents”.

Care England has called on the Government to clarify in the 2015/16 GP contract what constitutes an “enhanced” service for which GPs can charge, and what services should be free at the point of use. It said this information could also be added to the NHS Constitution to prevent any future ambiguity.

In June 2011 the British Geriatrics Society also published a report, Quest for Quality: An Inquiry into the Quality of Healthcare Support for Older People in Care Homes: A Call for Leadership, Partnership and Improvement, which criticised the practice of charging retainer fees. The society’s assessment of the situation regarding healthcare for older people concluded: “It tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 400,000 older people resident in UK care homes”.

Care England policy officer and author of the report summary Jamie Balbes said Monitor and NHS England will be publishing reports on this issue in the near future.