Clinical Support to Care Homes in NCL

Dr Shani Gray, Dr Katie Coleman & Paul Gouldstone

8th July 2020

• Current clinical support to care homes

• Primary care networks explained

• Enhanced Health in Care Homes service

• 1st May response to Covid-19

• Pharmacy & medicines support

• Significant changes and challenges

• Questions and reflections (from you and to you)

Variable across and within 5 boroughs in NCLAlso depending on type of home (nursing, residential, LD or MH)

Some care homes have:• GP weekly reviews of residents• Dedicated care home teams & multidisciplinary teams:

CHAT (Enfield and Haringey)ICAT (Islington and Haringey)MEDICUS GP service (Enfield)MDTs (all of the above and Camden)LD and MH teams

• Pharmacy support (MOCH – medicines optimisation in care homes pharmacists)All homes have access to out of hours (OOH) services – rapid response, 111*6

All GP practices in NCL now part of primary

care networks (PCNs)

Each PCN is a group of GP practices which have 30,000-50,000 patients

between them

Each PCN now has todeliver a set of services to their patients which

NHS England have outlined

Many PCNs will be hiring additional staff in new roles (e.g. social prescribers, health coaches,

pharmacists) to deliver these services and work as an MDT

Enhanced Health in Care Homes (EHCH) is one of these services

which PCNs have to start delivering by 1st October 2020

Enhanced Health in Care Homes PCN Service• PCNs agree care homes for which they have responsibility with the CCG.

• Each care home to have a named clinical lead

• People entering the care home should be supported to re-register with the aligned PCN

• Agreed a simple plan how services operate with local partners (incl CHP) to deliver EHCH

• PCNs to establish and coordinate an MDT to deliver services• Includes developing personalised care and support plans with people living in the

PCN’s Aligned Care Homes

• Weekly home round and review of priority residents• Have consistency of staff in the MDT• Personalised Care and Support Planning through MDT• Digital technology to support this work

• A PCN must establish protocols between the care home and with system partners for information sharing, shared care planning, use of shared care records, and clear clinical governance

Prioritise residents to review based on:• Clinical judgement• Care home advice• Anyone discharged from hospital within 7 days• Any new admission to the care home within 7 days

Residents should have personalised care and support plans:• Developed with residents and their carers• Use principles of a Comprehensive Geriatric Assessment

(consider physical, psychological, functional, social and environmental needs)• Meet end of life needs (where appropriate)

Support discharge from

hospital and transfer of care

between settings

Can be a

virtual review

Above done by members of the

MDT with consistent input

from a GP or geriatrician

Primary care and community health services to provide support to care home residents by mid May

• Named clinical lead for each home• Weekly check-in:

• Suspected or confirmed covid-19• Any other clinical priority patients• Delivered by an MDT where possible• Remote monitoring of Covid-19 patients using

equipment• More frequent reviews when needed

• Personalised care and support plans

• Pharmacy and medication support• Facilitating medication supply to care homes, including end of life medication• Structured medication reviews • Supporting reviews of new residents and those recently discharged from hospital• Supporting care homes with medication queries and facilitating medicines needs

with the wider healthcare system (e.g. through medicines ordering)

• Clear OOH support

• Secondary care providers should accept referrals and admissions from care home residents where clinically appropriate

• Facilitating medication supply to care homes, including end of life medication

23 pharmacies across NCL now stock EOL medicines. Support and training being offered to set up proxy ordering so that Care homes can order medicines on behalf of their residents. Training on Re-use of medicines provided to care homes.

• Delivering structured medication reviews via – video or telephone consultation where appropriate – to care home residents

Team of pharmacists-2 Barnet, 1 Enfield and Haringey and 1 Islington who offer support to Care Homes. PCN pharmacists-104 across NCL will also be able to offer support.

• Supporting reviews of new residents or those recently discharged from hospital

Residents discharged form hospital frequently have more issues with medicines, if you know of new residents or recently discharged residents then let your Care homes or PCN pharmacist know.

• Supporting care homes with medication queries, and facilitating their medicines needs with the wider healthcare system (e.g. through medicines ordering)

In each borough have set up a single access point which staff can contact for any questions about medicines, however simple or complex.

Examples of Medicines queries

Clinical Support to

Care Homes

Re-registration of residents to

different GP surgery

Care homes which sit across 2

boroughs

Setting up MDTs

Delivering weekly reviews

High quality personalised

care and support plans

Different groups/services

working together

Shared care

records

Pharmacy and

medicines support

Questions and Reflections?

1. How would you like to be involved locally in shaping services?

2. What has worked well for you in terms of clinical support?

3. What role would you want the home’s clinical lead to take?

4. What frequency of MDTs makes sense to you?

5. What are the key services your home needs access to so that residents have the right clinical support?