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One in 10 GP practices decline £20,000 unplanned admissions DES

Exclusive One in 10 GP practices in the north, Midlands and east of England has turned down the unplanned admissions DES, despite it being worth £20,400 to the average practice, Pulse can reveal.

The figures, obtained by Pulse, represent more than half of England’s GP practices and reveal that 4,031 out of 4,531 - 89% - signed up by the 30 June deadline.

LMC leaders said that many practices did not feel the workload was worth the significant chunk of money.

The new DES was funded via the retirement of 40% of the QOF and was part of a package intended to reduce bureaucracy compared with the arduous 2013/14 contract. However, many GPs disagreed with the analysis, arguing the DES workload was too heavy.

Under the terms of the DES, GPs are expected to identify the 2% most vulnerable patients on their list to set out individualised care plans, provide telephone access to advise on hospital transfers or admissions and reviewing unplanned admissions and readmissions.

Area teams in London and the south of England were still calculating take up, while Arden, Herefordshire and Worcestershire - where only 87 out of 234 GP practices are signed up to date - was excluded from the figures above because it has extended the deadline for signing up to 18 July.

But despite almost 90% of practices intending to do the DES, LMC leaders remained sceptical that it would bring added value to practices or patients.

Dr Bob Morley, medical secretary of Birmingham LMC said: ‘Like everything unfortunately practices tend to sign up to any bit of additional income that they can get and quite often tend to look at the top line rather than the bottom line, you know, of how much work is it going to cost them and what is the profitability of signing up.’

A Pulse snapshot survey of over 400 GPs earlier this year indicated that one in seven GPs would refuse to take on the DES, however several LMC leaders in the south of England have now said almost all practices have initially signed up to do it because of its significant financial value.

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, said: ‘Some practices are saying that the money isn’t worth it, that it is not enough money to cover the workload but virtually all have signed up to it, at least initially. Whether that will continue once they realise how hard work it is, we will see. It seems to be very bureaucratic.’

Meanwhile, Gloucestershire LMC chair Dr Phil Fielding said all local practices had signed up despite uncertainty of whether the DES would be successful.

He said: ‘In our punch-drunk state we have all signed up to it but the detail is very difficult to decipher, how it will be delivered. Only that we will find a way of incorporating any funding we can get to try and help bolster the service we provide. If you’re asking me if we have a grand plan, I don’t think we have. I think we have hopes and aspirations which the CCG wants to develop.’

‘But I don’t think anyone has the solution because the demographics tell us a story, that as our population ages and we get more complicated healthcare issues we are going to spend more, and anyone who says we can spend less and do the same I’m afraid probably isn’t a clinician.’

GPC deputy chair Dr Richard Vautrey said the figures were ‘in line with what we would expect’.

He added: ‘While there is a lot of work to do to fulfil the requirements of this new enhanced services there is also a significant resource linked to it and at a time of big cutbacks this is money that is essential for running the practice. In addition we hope that CCGs are supporting practices through the investment of the £5 per patient they are expected to use for this agenda.’


Name of area team

Take-up of Avoiding Unplanned Admissions DES

Total number of practices

North Yorkshire230233
South Yorkshire194215
West Yorkshire310328
Cheshire, Warrington & Wirral159170
Greater Manchester484499
Cumbria, Northumbria, Tyne & Wear260304
Durham, Darlington & Tees154172
Birmingham, Solihull and the Black Country381476
Shropshire and Staffordshire208243
Derybshire and Nottinghamshire263273
Leicestershire and Lincolnshire226248
East Anglia242292
Hertfordshire and the South Midlands240317


Excluded because of extended deadline:  
Arden, Herefordshire and Worcestershire87234

Source: NHS England

NOTE: Greater Manchester numbers were amended at 14.55 4 July after correction issued by NHS England.


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Readers' comments (11)


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  • I BLAME THE DAILY MAIL for vicious and rabid attacks on General Practice, especially PAUL DACRE-the MULTI-MILLIONAIRE GP hating editor.
    How Can we be responsible for agencies that we have no jurisdiction over??
    Any answers???

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  • This is not new money, it is recycled money.
    Yes, I don't blame them, they just want to be left alone rather than micromanaged by politicians.

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  • More should have taken the hit.
    Its only when area teams cost out the service to backfill for the practices that have had the resolve to opt out that they will realise what excellent value Primary GP was before it was being bled to death.
    if you have opted out do NOT do a single item of the work attatched to the DES, it is NHS Englands job to get the provision for your patients not yours.

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  • These DESs/LESs/NESs/QPs etc

    How are these reducing bureaucracy in any way? Its just more of the same, in a different name.

    Our CCG introduced a LES which overrides much of the work with the unplanned admissions DES, and no one at the CCG has a clue whether why is something that needs replicating.

    Meanwhile, the actual gold standards framework meetings for palliative care, which we ran successfully in the past, has had to be replaced by this.

    There really isn't any joy to being a GP anymore.

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  • Don't know why they declined it.
    Yes it's an extremely dumb idea from a criminal health secretary prostituting himself for votes in the silly season.
    But the care plans are a doddle to do, take me about 1 minute to complete.
    We've done 80 already.
    There have been plenty of other extremely stupid tasks we've been ordered to do over the years but still done them.
    This one now simply blends in with all the others.
    If our next DES was forcing GPs to eat grubs in the jungle we'd do that too, so spineless, divided and pathetic are we as a profession.

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  • The GPC is totally spineless. One wonders where their affinities lie, as 100 practices go under, in spite of each doctor seeing 40+ patients each day. Surely there is something wrong with this Contract that allows such a situation. The GPC should ballot for mass resignation. If we stay in this rubbish, at least it is our choice.

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  • In other words 90% complied.So that's what you call passive resistance

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  • The attitude of your local NHS England towards practices plays a part.If they have already heaped local b*s on top of national; if they have rejected payment claims for "wrong forms" ,wrong colour paper used, did you provide any other treatment service as this is a health promotion issue and you can't do both in the same consultation" then it does worry you as to how much like "War and Peace" your individual care plan must be to get paid.
    If you have insufficient community nursing support for your care plan objectives because your local aspirant Community FT built its Monitor plan on making 2.5 million pound saving per anum from not recruiting to district nurse vaccancies; If you have been constantly berated as a GP for higher than national average emergency admissions on patients you could not dare to leave at home as the remaining nurses are too stressed and thinly spread to care safely- then you probably cannot be bothered to even start the process because you are that busy firefighting a collapsing dysfunctional local health economy.
    If the local hospitals cannot cope with the volume of GP referrals necessary to stop people dying because of insufficent community "hands on "staff then a "care plan" is as useful to your business's continuing safe delivery of care to patients as a deckchair seating plan would have been to passengers on the Titanic.

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  • In Kent and Medway it seems all Practices signed up - are they real?

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