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GPs to be allowed to drop unplanned admissions DES and retain funding under CCG plans

Exclusive GPs in one area of England will be given the chance to drop the unplanned admissions DES from April and instead receive payment for advance care planning and end-of-life care for 0.5% of their patient lists.

Speaking at the Pulse Live conference in London today, Dr Graham Jackson, chair of NHS Aylesbury Vale CCG, also revealed that it will offer GPs the chance to drop certain elements of the QOF as soon as the CCG takes on ‘joint commissioning’ responsibilities alongside the local area team in April.

Dr Jackson explained how the CCG wanted to develop detailed information about the quality of care planning, instead of spending lots of money on ‘achieving very little’.

This is the biggest change to the GP contract announced by a CCG taking on co-commissioning responsibilities, after Pulse revealed that at least 12 CCGs were considering dropping the QOF.

More than 70% of all CCGs have taken on some form of co-commssioning responsibilities, at either Level 2 – allowing ‘joint commissioning’ alongside NHS England local area teams – or Level 3, which gives them full delegated responsibility for commissioning primary care.

NHS Aylesbury Vale CCG has taken on Level 2 ‘joint commissioning’ powers alongside the local area team under co-commissioning, which NHS England hopes will improve sustainability and effectiveness of primary care.

The plans, approved by the NHS Aylesbury Vale CCG board last week, will enable GPs to drop NHS England’s flagship scheme, which requires GPs to develop care plans for their most vulnerable 2% of patients.

Instead they will be asked to conduct and review the advance care plans of 0.5 % of the practice population, half of the population at risk of dying within the year.

The GP will register the patient’s preferences on where they wish to die, and then conduct quarterly audits of the deceased population to investigate whether their place of death matched these wishes.

GPs will also be offered the chance to opt out of all diabetes-related QOF domains, and receive payment at their level of achievement last year and potentially 20% on top, in exchange for running CCG-funded staff training on long-term conditions care planning.

Dr Jackson added that the dementia and respiratory QOF domains could also be added to the scheme in future.

He told Pulse Live delegates: ‘We’re offering our practices suspension of the unplanned admissions DES as it stands. And then we’ll rewrite it to say that we’re interested in what’s happening with quality at end of life, we’re interested in where they die: do they die in the right place? Are their advance care plans properly structured?’

Speaking to Pulse afterwards, Dr Jackson added: ‘Essentially, we’re looking at quite a few deaths. We say that 1% of your population are predicted to die in a year. We’re saying let’s take half of that population, and what we want to know is are people dying in the right places.’

He added: ‘At the moment, we are spending big money on the unplanned admissions DES that really is achieving very little.’

Readers' comments (13)

  • replacing one lot of tick boxes with another - hardly medicine

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  • i've lost track of the number of changes we are at now?

    it all appears confusing and like a system out of control with desperate u-turns and fixes to patch things up.

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  • disagree with above comments. i think this is what ccgs who co-commission should be doing. the current des is a waste of time in my opinion but the concept of care planning and supporting patient involvement in their care is not. lets focus work on something that addresses a known problem i.e. end of life care. care planning and the 'house of care' model is a significant shift in how people with LTCs are managed and i feel it is better than the current tick box qof, medicate, medicate then medicate again approach to care. We need to engage with complex patients with multimorbidity and work with them on their priorities whilst supporting them, educating them and advising them based on our clincal knowledge and expertise. These changes take time and require funding. these are not u-turns and patch ups but rather an attitudinal change for the health system that mirrors what patients with LTCs need. I do agree however that tick boxing needs to be discouraged as it creates a situation where data recording becomes more important than good clinical care. Next stop - lets have serious discussions about the future of the monster that has become qof

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  • Vinci Ho

    QOFs to be replaced by more Care Plans???
    Werner Heinsenberg's uncertainy principle in quantum theory stated that , you could ask questions about the characteristics of a system under scrutiny but there were certain combinations of questions which had no answers.
    To me , certain qualities just cannot be 'measured'.Hence , there is a factor of randomness , thus flexibility has to be allowed.
    Niels Bohr , rival of Einstein , told him randomness is the fundamental. Some effects have no cause and told him off ,' Einstein , stop telling God what to do .'

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  • Agree that more care plans not necessarily the answer. The 'care plan' should not be central to this rather the process and discussions involved in care planning. To be honest this is what most good GPs were doing to some extent prior to qof - applying medical knowledge to the individual patient who they have built up a relationship with over time and who they have an in depth understanding of.

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  • Do we really think that nursing care has improved with the demand for completion of lengthy care plans? There are rarely nurses walking about on the wards because they are shut away in a nursing station cut and pasting lengthy care plans that are all the same and no one ever reads. This is not good clinical care but an IT exercise. Let us not fall into the same trap as the poor nurses who no longer have time for nursing.

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  • Planning to drop the Unplanned (admissions).

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  • agree fully with 9.40

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  • well said 9:40. less time spent planning and form filling more time spent doing. less micromanagement and leave well trained professionals to exercise judgement and treat their patients according to their need rather than care palns for everyone whether you need it or not.

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  • Totally agree with comment at 9.40. Care plans are a medico legal/admin construct from the world of nursing which have no place in general practice.

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