Enhanced Health in Care Homes (EHCH), Explained in Plain English

By Len Burgess, Senior Care Advisor · Published 2 June 2026

The Enhanced Health in Care Homes framework: what it is, what the seven core elements are, and what families and care providers should expect from it in 2026.

The latest post in our Care Jargon Buster series covers the NHS framework that quietly shapes how every care home and nursing home resident in England now receives medical care. The Enhanced Health in Care Homes framework: what it is, what the seven core elements are, and what families and care providers should expect from it in 2026.


If you have a relative in a care home or a nursing home, or if you run one yourself, you will increasingly hear the term Enhanced Health in Care Homes (EHCH). Care, home managers refer to it.

GPs talk about it. Hospital discharge teams reference it. NHS commissioners use it in every document about care home health support.


And yet most families have no idea what it is, and many care home staff would struggle to explain the framework they are now contractually expected to work within.


This post is the canonical guide that the rest of our Jargon Buster series has been pointing toward. We have referenced EHCH in our posts on the MDT, GPs, Allied Health Professionals, physiotherapists, and occupational therapists. Here is the framework itself.


A quick orientation note. EHCH is the framework for delivering joined-up healthcare to people living in care homes. It is not the same as an Enhanced Care Unit (a hospital ward setting providing care between a general ward and intensive care), nor an Enhanced Care Worker (a staff role in some social care providers).


Those are separate concepts. If you are here for the NHS care home framework, read on.


What is the Enhanced Health in Care Homes framework?

EHCH is the NHS England framework that defines how primary care, community services, hospitals, and social care should work together to deliver proactive, joined-up healthcare to people living in care homes.


Before EHCH existed, the medical care of care home residents was largely reactive. A resident would get unwell, someone would call the GP, the GP would come (or not), and the rest of the system would respond as needed.


There was no consistent expectation about how often residents were reviewed, who was responsible for medication reviews, how hospital discharges would be handled, or how the wider healthcare system would support the home. The result was widely variable care, frequent avoidable hospital admissions, and a system that did not work well for some of the most vulnerable people it served.


EHCH was designed to change that. It was launched in 2016 as part of NHS England's Five Year Forward View, piloted through six "vanguard" sites, and then rolled out across England as a statutory part of the Primary Care Network (PCN) Direct Enhanced Service (DES) contract from 2020. The framework has been updated several times since, with Version 4 published on 31 March 2026.


A few essentials to lock in:



How does the EHCH framework actually work?

EHCH is structured around seven core care elements, each of which the NHS, the PCN, and the care home are expected to deliver together. They are designed to wrap proactive, coordinated healthcare around each resident from the moment they move in.


1. Enhanced primary care support. Every care home in England is aligned to a named Primary Care Network, with one GP practice within that PCN taking lead clinical responsibility. Every resident has a named GP. The headline commitment is a weekly home round, a structured visit by the GP or clinical lead to review residents proactively, rather than waiting for someone to become unwell.


2. Multidisciplinary team (MDT) support. Each home has an MDT wrapped around it, including the GP practice, community nursing, pharmacists, and (when needed) physiotherapists, occupational therapists, speech and language therapists, dietitians, mental health practitioners, social workers, and voluntary sector workers. The MDT meets regularly to review residents, agree on care plans, and support the home's clinical decisions.


3. Personalised care and support planning. Every new resident must have a comprehensive personalised assessment within 7 working days of admission or re-admission, and a Personalised Care and Support Plan (PCSP) developed with the MDT. The PCSP is the resident's individual roadmap, covering health needs, preferences, treatment escalation plans, and end-of-life wishes.


4. Structured medication reviews (SMR). Every care home resident should be identified as a priority for a structured medication review, conducted by a clinical pharmacist or GP. Older people in care homes are often on multiple medications, and a proper review reduces side effects, drug interactions, and avoidable harm. The pharmacist's role is one of the most important parts of EHCH and is often underused.


5. Falls prevention and management. Care home residents are three times more likely to fall than older people living in the community. EHCH builds proactive falls prevention into routine care, with physiotherapy assessments, environmental review, footwear and gait checks, and medication review of drugs that increase falls risk.


6. Nutrition, hydration, and wider clinical support. This element covers what the framework calls the "everyday clinical" support care homes need, including IDDSI-based safe swallowing assessments, hydration monitoring, nutrition support through dietitians, pressure ulcer prevention, and skin and wound care (including leg and foot ulcers).


7. Hospital discharge support. When a resident is admitted to the hospital, EHCH builds a structured discharge process to ensure the move back to the care home is coordinated. The hospital, the GP practice, the PCN, and the home all work together to make sure the discharge plan is safe and that the resident's care continues without disruption.


Behind these seven elements sits a series of practical requirements. Every care home must have established protocols with its PCN for information sharing, shared care planning, shared care records, and clear clinical governance.


Vaccinations (seasonal flu, COVID-19, RSV) must be offered to all eligible residents through the PCN. And the whole framework is overseen by the local ICB, which is responsible for commissioning and monitoring delivery.


Who is generally approved to benefit from the EHCH framework?

This is one of the most important things to understand about EHCH: it is not approval-based. There is no application process, no eligibility test, no means assessment. Every person living in a care home in England, in either a residential or nursing setting, is automatically covered by the framework. It does not matter how the care is funded (self-funded, council-funded, or NHS Continuing Healthcare), how old the resident is, or what condition they have.


In practice, this means that the moment your relative moves into a care home, they are entitled to:



Two practical caveats. First, residents can choose to keep their existing GP if it is geographically possible, even when that GP is not in the aligned PCN. But doing so means losing access to the full EHCH service, including the weekly home round and the proactive care that comes with it.


Most families find the trade-off in favour of moving to the aligned practice. Second, EHCH does not replace specialist care or any other NHS service. If your relative needs hospital treatment, a cancer clinic, or a mental health team, those services continue separately.


How does this apply to me?

These are the five questions families and care providers ask most often about the EHCH framework.


1. How do I know if my relative's care home is delivering on EHCH properly?

A good care home should be able to answer these questions clearly, in plain English.


Which PCN is the home aligned with? Every care home in England should have a named PCN.


Which GP practice takes lead clinical responsibility? There should be one practice doing the heavy lifting, not a scatter of unrelated GPs.


Who is my relative's named GP? Every resident should have one.


How often does the weekly home round happen? It should be weekly, even if not every resident is reviewed each week.


When was my relative's most recent Personalised Care and Support Plan review? It should be reviewed regularly, particularly after any health change.


Who is the home's clinical lead? This is the named individual responsible for coordinating EHCH at the home, often a senior nurse or registered manager.


If the home cannot answer these questions clearly, that is a real warning sign. Good homes treat their EHCH arrangements as one of the most important aspects of resident care, and they will be proud to explain how it works.


2. What is the difference between EHCH and CQC?

These are two completely different things, and the difference matters.


The Care Quality Commission (CQC) is the regulator of social care and healthcare in England. CQC inspects and rates care homes, checking that the home itself is safe, effective, caring, responsive, and well-led. CQC has the power to require improvements, restrict admissions, and ultimately close homes that are not meeting standards.


EHCH is an NHS framework that defines how the wider health system supports residents living in those homes. It is delivered by the PCN, the ICB, and the community services, not by the home itself.


In practice, the two work together. CQC inspectors increasingly look at how a home is using EHCH as evidence of good clinical care. And a home running EHCH well is in a stronger position at inspection because the framework provides a structure for everything CQC wants to see, including personalised care planning, medication safety, falls prevention, and integrated working with the wider NHS.


3. What happens when my relative is admitted to the hospital under EHCH?

When a care home resident is admitted to hospital, the EHCH framework requires a coordinated discharge process. The hospital should communicate with the home, the named GP, and the PCN as soon as admission happens.


Discharge planning should start early, not at the last minute. The home should be involved in agreeing on what care needs to be in place before the resident returns, including any equipment, medication changes, or escalation plans.


For families, the practical things to do are: make sure the hospital knows your relative is a care home resident, ask which discharge coordinator is handling the case, and stay in close touch with both the hospital and the home during the admission.


If discharge is approaching and you have not heard about the plan, ask. The home's clinical lead or registered manager should be involved before your relative returns.


4. Does EHCH apply to home care?

No, not directly. EHCH is specifically designed for people living in care homes and nursing homes, where the residents are in a shared setting with the same provider responsible for their care 24 hours a day. If your relative is living at home with home care visits from a domiciliary care agency, they remain in the standard NHS system: registered with a GP, supported by community services, and using PCN home visiting services where housebound.


That said, the principles of EHCH (proactive care, MDT support, personalised planning, structured medication reviews, falls prevention, coordinated hospital discharge) increasingly inform community care for older people more broadly. Many of the same professionals who work in care homes through EHCH also visit people at home through community teams.


If your relative is at home and you think they would benefit from a more coordinated approach, raise it with their GP. Many practices now have older people's clinical leads who can pull together a proactive plan even outside the EHCH framework.


5. How do I find out which PCN my relative's care home is aligned with?

Three routes. Ask the care home directly. A well-run home will know its PCN and the lead GP practice immediately. Ask the GP practice your relative is registered with. They will tell you which PCN they belong to and which care homes the PCN covers. Check the NHS website, which has a "Find your PCN" tool you can search by postcode.


Once you know the PCN, you can also look up its services on the PCN's own website, which most now maintain, including information on which clinical leads cover care homes, how the MDT is structured, and which extended services (like clinical pharmacist sessions or paramedic visits) the PCN delivers.


The takeaway

The Enhanced Health in Care Homes framework is one of the most consequential things to happen to care home medicine in England in a generation. It moves care homes from being passive recipients of healthcare to being active partners in a coordinated system, with proactive support wrapped around every resident from the day they move in.


For families, EHCH is genuinely empowering. It gives you the right to expect certain things from your relative's care home and the NHS services that support it. Knowing what those are, and being willing to ask, is the difference between a passive experience of the care system and an active one.


Three practical takeaways. Ask the questions in FAQ 1 of any care home you are considering, or where your relative already lives. Make sure their PCN alignment and named GP are clear, particularly after admission, because this is the foundation of everything else. And read our other guides on the MDT, GPs, Allied Health Professionals, physiotherapists, and occupational therapists, all of which connect back to this framework.


Our funding calculator can show you how the cost of care fits alongside other NHS and council support, including FNC, CHC, and the means test. Our wider Jargon Buster series explains every term you will come across, with EHCH at the centre of the network connecting them.


This article is for general guidance only and reflects the Enhanced Health in Care Homes framework Version 4, published by NHS England on 31 March 2026. The framework applies to care homes in England; Northern Ireland operates a separate Enhancing Clinical Care Framework, and Scotland and Wales have their own care home health programmes. For specific advice on EHCH delivery in your area, contact the care home's registered manager, your local Integrated Care Board, or the NHS England EHCH team.

Sources

Frequently asked questions

What can I do if my relative's care home does not appear to be delivering EHCH properly?

Several routes are available. First, ask the registered manager directly and politely about how the home is working with its aligned PCN, who the clinical lead is, when the last weekly home round happened, and when your relative's Personalised Care and Support Plan was last reviewed. A good home will answer confidently. If the answers are vague or contradictory, the issue may be with the home, the PCN, or both. Second, raise concerns with the aligned GP practice, particularly if the issue is that the practice itself is not visiting or engaging. Third, contact the local Integrated Care Board (ICB), which is responsible for commissioning EHCH and has a duty to act if delivery is not meeting requirements. ICB contact details are available through the NHS website. Fourth, contact the Care Quality Commission if you have wider concerns about how the home is being run, because CQC inspectors look at EHCH delivery as part of the inspection framework. As a final option, a formal NHS complaint can be made through the standard NHS complaints process.

Do smaller or rural care homes get the same EHCH support as larger urban ones?

In theory, yes, in practice it varies. Every care home in England, regardless of size or location, should be aligned with a PCN and entitled to the full EHCH service. The contractual requirements on PCNs apply equally. In reality, rural areas sometimes face challenges with travel distances and GP capacity, which can mean weekly home rounds are delivered differently (sometimes shared between practices, sometimes supported by paramedics or Advanced Clinical Practitioners rather than GPs). Smaller care homes can also sometimes feel like they get less attention than larger ones because the same MDT may support multiple homes in a PCN area. The framework allows local flexibility in how the seven elements are delivered, but it does not allow them to be dropped. If you are choosing a care home and the rural or small-home context matters, ask specifically how the EHCH service is delivered for that home and what backup arrangements exist when the main GP is not available.

What is the role of the ICB in EHCH delivery?

The Integrated Care Board (ICB) is the statutory NHS body responsible for arranging and commissioning EHCH services in each area, alongside everything else the NHS delivers locally. Specifically, the ICB is responsible for ensuring every care home in its area is aligned to a PCN, monitoring that PCNs deliver against the EHCH framework requirements, commissioning the community health services that wrap around EHCH (district nursing, community therapy, mental health services, pharmacy), and stepping in when the framework is not being delivered properly. From 1 April 2026, the previous ICB structure of 42 ICBs in England was consolidated to 26, with further mergers planned, as part of the wider NHS reorganisation. This means the ICB that commissions your relative's care may have changed name or boundary in 2026, although the EHCH framework and services should continue uninterrupted. If you need to raise a concern about EHCH delivery, the current ICB website (searchable through the NHS organisation finder) is the right starting point.

How does EHCH support residents at the end of life?

End-of-life care is one of the most important areas EHCH is designed to improve, although it is sometimes overlooked when people describe the framework. Several elements work together. The Personalised Care and Support Plan should include the resident's wishes about end-of-life care, including any treatment escalation plans, advance decisions, and preferences for hospital admission. The MDT brings in palliative care specialists, district nurses, and Allied Health Professionals as needed. The named GP provides continuity through the final stages. The structured medication review addresses comfort and symptom control. And the hospital discharge support principle reverses if needed: helping someone come back to the care home from hospital to die rather than remaining in an acute setting. Families with a relative approaching end of life should ask the home and the GP team for an explicit end-of-life conversation early, while their relative can still participate in decisions, and request that the PCSP is updated accordingly.

How does EHCH interact with NHS Continuing Healthcare (CHC) and Funded Nursing Care (FNC)?

These are separate frameworks, but they connect at the care planning level. EHCH is the framework for how the NHS provides medical care to residents. NHS Continuing Healthcare (CHC) is the funding route that pays for the whole cost of care for residents whose primary need is a health need. NHS Funded Nursing Care (FNC) is the weekly contribution the NHS makes to nursing home costs where the resident has nursing needs. EHCH applies to all care home residents regardless of how their care is funded; CHC and FNC are about who pays for the care itself. In practice, the MDT involved in your relative's EHCH care is often the same group of professionals who contribute to CHC assessments, and their notes and care plans form a meaningful evidence base for CHC eligibility decisions. If your relative is being assessed for CHC, ask for the EHCH-generated care records, MDT notes, and Personalised Care and Support Plan to be included as evidence. We cover CHC, FNC, the Decision Support Tool, and the MDT in detail elsewhere in this series.