Enhanced Health in Care Homes, or EHCH, is the NHS England framework for coordinated, proactive health care around people living in CQC-registered care homes, with or without nursing. It includes alignment with a primary care network, named clinical leadership, a regular home round, multidisciplinary working, comprehensive assessment, personalised planning, medication review and links with community services. This is not a premium package sold by the home, and it is not synonymous with a GP appearing once a week. Families can use the framework to ask how the resident’s health needs are anticipated, shared and followed through across the care home, general practice, pharmacy, community teams, hospital and end-of-life services.
Identify the aligned primary care team
Ask which primary care network is aligned to the home, which GP practice provides most residents’ care, and who is the named clinical lead for the EHCH model. Confirm how a resident registers, what happens if they wish to keep an existing GP, and how urgent advice is obtained outside normal hours. Record names and contact routes in the care plan.
The existing guide on GP registration and the weekly home round explains primary-care access. EHCH should add coordination around that contact: a clinical lead and multidisciplinary system are different from one clinician conducting a list of routine visits.
Check the admission assessment and plan
Ask how the home and multidisciplinary team complete the comprehensive personalised assessment after admission or readmission and how quickly it happens under the current framework. It should cover medical conditions, medicines, function, frailty, cognition, nutrition, oral health, skin, falls, continence, emotional wellbeing, communication, social goals and what matters to the person.
Require a personalised care and support plan that names actions, owners and review triggers. The care-plan review meeting checklist helps families turn broad aims into responsibilities. Ensure hospital information and the resident’s own priorities are reconciled rather than copied without discussion.
Make the multidisciplinary team visible
Ask who attends the care-home multidisciplinary team and how residents are selected for discussion. Depending on local services and need, participants may include general practice, community nursing, pharmacy, therapy, dietetics, mental health, palliative care, social care and the home. Not every professional attends every meeting, but referral and escalation routes should be clear.
For one resident, request a simple map: which professional leads each active issue, what was agreed, and when progress will be reviewed. “Discussed at MDT” is not an outcome. Ask how decisions reach night staff, agency staff, the resident and authorised relatives, and how contradictory recommendations are resolved.
Look for proactive care between rounds
Good EHCH practice detects deterioration before a crisis. Ask what baseline observations and soft signs staff know, how concerns are scored or communicated, and which service responds the same day. Review plans for falls, hydration, constipation, infection, skin, delirium, breathlessness, diabetes and recurrent hospital attendance according to the person’s risks.
Confirm access to urgent community response, diagnostics and specialist advice where locally commissioned. Technology may support communication or monitoring, but it should not replace examination when needed. Ask for an example of a recent change in condition and trace the timeline from the first observation to clinical decision and follow-up.
Use structured medication review properly
Care-home residents should be considered and prioritised for structured medication review based on clinical need. Ask who conducts it, how the resident participates, whether the community pharmacist or prescriber sees current monitoring, and how changes are communicated to the supplying pharmacy and administration record. The aim is not simply to reduce the number of medicines.
Review indication, benefit, side effects, interactions, burden, swallowing, timing, monitoring and the person’s goals. Set dates for blood tests or observations and identify who checks results. A review is incomplete if a medicine is changed but nobody confirms supply, administration and response.
Test the framework before choosing a home
During a visit, ask the manager to describe the aligned PCN, clinical lead, round, MDT, admission assessment, urgent-response pathway, pharmacy support, therapy access and information-sharing system. Request a de-identified example of how these elements prevented harm or improved quality of life. Staff on the floor should recognise the workflow.
Use the UK care-home search and comparison hub to build a shortlist, then verify EHCH locally because delivery can vary. A home should not claim that EHCH means continuous NHS nursing or guaranteed access to every community service. It should show how universal framework elements and locally commissioned support work for this resident.
Agree a one-page escalation plan for the resident. It should state their normal presentation, early warning signs, observations or questions staff should use, who to call by day and night, when to use urgent community response or emergency services, and who informs the family where authorised. Review what happened after every hospital attendance. If the same problem recurs, ask the MDT to change prevention, monitoring or treatment rather than simply record another transfer. This closed-loop review is a practical test of EHCH: information should return to the home and alter future care, not end at the weekly meeting.
Ask the home to show when the plan was last tested and updated. An unused escalation sheet with old telephone numbers is not coordination, however well the policy is written.
Is Enhanced Health in Care Homes only for nursing homes?
No. The NHS England framework covers CQC-registered care homes with or without nursing. The exact health input will reflect residents’ needs and local services. A residential home’s own staffing remains different from a care home registered to provide nursing.
Does EHCH guarantee a weekly GP visit for every resident?
The model includes a weekly home round supported by the multidisciplinary team, but that does not mean every resident receives a face-to-face GP appointment each week. Ask how residents are prioritised, who conducts the round and how urgent needs are handled between rounds.
Can a family attend the multidisciplinary meeting?
Attendance arrangements vary and confidentiality must be protected. The resident should be involved in personalised planning, and authorised relatives should receive relevant information. Ask how views are gathered before the meeting, how decisions are shared and how to request a case discussion.
EHCH delivery depends on current national requirements and local commissioning; confirm the resident’s pathway with the home and NHS team.
