Overview
NHS Continuing Healthcare (CHC) is a package of care funded by the NHS for individuals with complex ongoing primary health needs.
Eligibility is determined using nationally defined criteria based on four domains: nature, complexity, intensity and unpredictability. The process is coordinated by the ICB through the Continuing Healthcare team, often referred to as the All Age Continuing Care team.
Who is responsible for CHC assessments?
The CHC process is ICB-led and multidisciplinary, not GP-led.
Initial checklists are usually completed by a professional involved in the patient’s day-to-day care, rather than general practice, for example:
- Community nursing teams
- Care home staff
- Other involved health or social care professionals
If a checklist triggers a full assessment, the CHC team coordinates a multi-disciplinary team (MDT) Decision Support Tool (DST) process.
What is the GP role?
The GP role is supportive and information-based, rather than administrative or coordinative.
GPs may reasonably be asked to:
- Provide a summary of relevant medical history
- Share details of recent interactions (for example, previous three months)
- Highlight clinically relevant information from the record
- Contribute to MDT discussions where appropriate
This input is usually requested directly by the CHC team.
What GPs are not required to do
GP practices are not expected to:
- Complete CHC checklists
- Complete Decision Support Tool (DST) documentation
- Collate or validate third-party accounts of care needs
- Sign forms completed by relatives or care providers
- Lead or coordinate the CHC assessment process
Practices are not well placed to assess day-to-day functional needs, and it is not appropriate to complete forms based on second-hand information.
Requests directed to general practice are often made for convenience rather than because the GP is the most appropriate professional to complete the checklist.
Managing requests from patients and families
Practices are increasingly receiving requests from families to complete CHC paperwork, sometimes with the suggestion that a GP signature will carry more weight.
In these situations, it is reasonable to:
- Decline to complete the forms
- Explain that the CHC process must be initiated via the appropriate professional route
- Where relevant, advise that this would usually be the care home or community nursing team, rather than general practice
- Signpost to the CHC team, who coordinate the process
A consistent practice approach helps avoid creating ongoing expectations.
Practical approach for practices
A simple, consistent response can be helpful:
“CHC assessments are organised by the NHS Continuing Healthcare team. We are not able to complete these forms, but the team can arrange the appropriate assessment and will contact us if clinical information is needed.”
LMC position
The LMC view is that CHC processes should be:
- Led by the appropriate commissioning and community teams
- Based on input from professionals with direct knowledge of the patient’s care needs
- Supported by GP clinical information where relevant, but not reliant on GP completion of administrative processes
This approach supports appropriate use of clinical time, maintains professional boundaries, and ensures assessments are carried out by those best placed to evaluate patient need.