Care for patients who reside in specialist institutions

General Practitioners are required to deliver care in accordance with their primary care contracts, which include the General Medical Services (GMS), Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS) contracts. However, the way in which services are provided is determined by each individual practice.

Essential Services in GP Contracts

The essential services defined within the GMS and PMS contracts outline the core responsibilities of general practice. These contracts do not contain specific provisions requiring GPs to provide primary care services to patients who reside in specialised institutions, such as nursing homes, residential care homes, or secure units.

Since PMS and APMS contracts are negotiated locally, there may be specific provisions for the care of such patients, but only where this has been explicitly agreed upon through local contract negotiations.

What Essential Services Cover

The essential services component of GP contracts is referenced in regulations and outlines the care that GPs are obligated to provide for their registered patients and temporary residents. This includes:

1. Management of patients who are:

   • Ill with conditions from which recovery is generally expected.
   • Terminally ill.
   • Suffering from chronic disease, with care delivered as agreed between the practice and the patient.

2. Definition of disease and management responsibilities:

   • The term “disease” refers to any condition listed within the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
   • “Management” includes:
     • Offering consultations and physical examinations to determine the need for treatment or further investigations.
     • Providing necessary treatment and arranging further investigations or referrals where appropriate.
     • Liaising with other healthcare professionals involved in the patient’s care.

3. Ongoing treatment and patient care responsibilities:

   • Providing appropriate treatment tailored to the patient’s individual needs.
   • Offering health advice and promotion.
   • Referring patients for additional services under the NHS where necessary.

Why Care in Specialised Institutions Falls Outside Essential Services

Patients residing in specialist institutions often require highly individualised, multidisciplinary care that extends beyond the scope of essential GP services. This is because:

• The nature of care required in specialist institutions is, by definition, specialised.
• GPs are not contractually required to provide such services unless explicitly agreed upon through local PMS or APMS arrangements.
• Asking GPs to deliver care beyond their competence places both patients and clinicians at risk.
• Providing care outside a GP’s expertise could conflict with the standards set by the General Medical Council (GMC) in Good Medical Practice, which emphasises the importance of working within one’s competence and referring appropriately.

Conclusion

While GPs play a crucial role in delivering comprehensive, patient-centred care, the limitations of primary care contracts must be acknowledged. Specialist institutions require bespoke healthcare solutions, often involving multidisciplinary teams with specialist knowledge and skills beyond the remit of general practice. Ensuring that these patients receive the right care in the right setting is vital for both patient safety and clinician accountability.