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Primary care networks working with community services

 

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Primary care networks working with community services

The NHS Long Term Plan outlined how the Enhanced Health in Care Homes model across England would be implemented, which moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff.

The model is included in the primary care networks (PCNs) Directed Enhanced Service (DES) for 2020/21, as well as the NHS Standard Contract. PCNs working with community services have been asked to:

  • deliver a weekly ‘home round’ to aligned care homes;
  • work with multidisciplinary teams to develop and refresh the personalised care and support plan for the patients living in your aligned care homes;
  • support with a patient’s discharge from hospital and transfers of care between settings, including giving due regard to NICE Guideline 271.

The Enhanced Health in Care Homes Framework provides helpful advice on achieving this and should be read alongside these contractual requirements.