GPs Should Prescribe Social Care, Says Hewitt

Family doctors will be allowed to use NHS money to prescribe social care support such as home helps and respite breaks for carers under plans to be announced by the government today. GPs will also be encouraged to spend NHS funds on home aids or adaptations such as grab rails or even relaying carpets where an elderly or disabled person may be at risk of falling or tripping – avoiding a large health service bill for emergency hospital treatment.

{mosimage}The proposals, which will be announced today by the health secretary, Patricia Hewitt, represent the biggest shakeup of the rules governing commissioning of health and social services since the health service was set up after the second world war. Ms Hewitt will set out the government’s consultative proposals for a commissioning framework for health and wellbeing, which have been drawn up jointly with communities and the local government secretary Ruth Kelly, at a Guardian conference on integrated health, social care and housing services.

Some GPs are already commissioning services imaginatively within the rules, Ms Hewitt will say. They prescribe exercise for patients who are overweight, supply self-monitoring equipment and make available social work, counselling and occupational therapy services.

But there is a need now to go further, the minister will add, by giving GPs and their primary-care colleagues reassurance that they will not be stepping beyond legal limits if, by agreement with their local authority and NHS primary care trust, they decide to use health money to buy social care services.

The framework states that while it is “not normally reasonable” to use NHS funds on community care services as defined in the 1990 Act it can be done where “the provision of such services is necessary to meet a health need” or where there is a formal partnership and pooling of funds between a PCT and local authority.

Ms Hewitt said her department had evidence that every pound spent on social care saved the NHS 30p. Some research suggested that the savings to the NHS were as much as 80p per social-care pound.

Her comments risk provoking a backlash from local authority leaders who say they are having to make cuts in their 2007-08 budgets, in which adult social care is the biggest element, because of “cost-shunting” from cash-strapped PCTs that are reducing services for elderly and disabled people. In London councils claim they are inheriting £35m of NHS debts in this way.

Allowing GPs to spend NHS money on social care is also likely to raise issues of equity, as their patients will be receiving a free service that other people, who receive the same service from their local authority, pay towards under social care means tests.