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Palliative Care and Nursing Homes Consultation: Key Requirements and Contract Issues

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Discussions at the Clinical Commissioning Forum (CCF) on Nursing Homes Contract, FHV Requirements, and Palliative Care Contract. Addressing concerns, eligibility, payment structure, patient care plans, and more.

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Palliative Care and Nursing Homes Consultation: Key Requirements and Contract Issues

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  1. CLINICAL COMMISSIONING FORUM FHV, Palliative Care and Nursing Homes CCG contracts Consultation at CCF on 5 February 2015

  2. Nursing Homes Contract • Key requirements as follows: • Weekly session at Nursing Home 1-3 hours depending on number of patients • Weekly MDT at Nursing Home • New patient assessment • Annual review of each patient • Record information in notes at Nursing Home as well as in medical record • Payment £1.20 per patient per day

  3. Issues about Nursing Homes contract • Could we combine it with FHV. CCG thinks not as the FHV contract does not need the requirements in terms of weekly sessions and weekly MDT • Are there any homes that should be eligible and are currently not? Only applies to two Homes and 2 practices in Hackney at present • Needs to be clear that patients cannot be under Nursing Home contract and FHV contract – only one or the other

  4. Requirements of FHV contract • City and Hackney Care Plan • Lead GP • Housebound patient • Pro-active visits 2-8 p.a. • Review of care plan at each visit (not being counted at present) • Monthly Practice MDT • Quarterly quadrant MDT

  5. Issues about FHV • Current spec states that there should be a register of patients and a maximum of 3.5 visits x register size and register size is capped for each practice – is the cap fair? • Current coding and payment is based on housebound code and chronic home visit code so practice could do 2 visits only on a larger number of patients or 8 visits on a smaller number so payment is based on a visit cap – is this fair? • Can we develop a more sophisticated way of deciding what the register should be for each practice depending on list size or number of patients >75 or number who are housebound??? • Are we comfortable for housebound palliative care patients to be on FHV or is this GMS work?

  6. Palliative care contract • Lead GP • Register of patients who are in last year of life (may be housebound or not) • Advance Care Plan agreed or declined • On CMC – or CMC declined • Support for patients to die at home if they wish

  7. Issues about Palliative care contract • Codes for palliative patient, ACP and CMC need to be provided by CEG. Do you want them on same template as FHV or as sub template or separate template? • Should patients be on FHV list once they become housebound or is this part of GMS?

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