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Gold, incentives and meh

Practices told to reduce emergency admissions to receive £5 per patient funding

Exclusive GPs have been told by CCGs they will have to hit targets for cutting avoidable emergency admission rates to receive funding worth £5 per patient promised to them to support the care of elderly patients, Pulse has learnt.

A Pulse investigation reveals that 86 of 150 CCGs have not yet committed funding to support GPs in rolling out the new emergency admissions DES and supporting the care of elderly patients, despite a pledge from NHS England to commit £5 per patient to fund this.

The investigation also reveals that at least four CCGs have made the funding conditional on targets being met, including reducing admissions rates and care home interventions.  

GP leaders said it was ‘wholly inappropriate’ to set targets to reduce admissions rates.

Pulse sent a Freedom of Information request to CCGs across England asking how they were intending to identify and spend funding cited for ‘transforming the care of patients aged 75 or older’, which NHS England said ‘should be at around £5 per head of population for each practice, which broadly equates to £50 for patients aged 75 and over’.

How the money is being spent

  • About 10% of CCGs said they have already committed to giving the full £5 per patient to GP practices;
  • 16 out of 150 CCGs said they are giving some proportion between nothing and £5 to GP practices;
  • 10 CCGs said GPs had to earn this extra cash through measures such as additional care in nursing homes, care planning and medicines reviews in care homes;
  • 11 CCGs described services they were commissioning that would not directly involve GPs.

NHS West Suffolk CCG and NHS Ipswich and East Suffolk CCG have made half of this funding dependant on whether practices have delivered on ‘agreed outcomes’ by April 2015. It added: ‘All schemes are expected to contribute towards a reduction in avoidable emergency admissions in patients aged 75 and over.’

NHS East Leicestershire and Rutland CCG has also agreed to give half the funding upfront, with the remaining 50% to be based on targets, including those relating to COPD, diabetes and atrial fibrillation.

Meanwhile, NHS Leeds South and East CCG will give GPs up to £5 depending on achievement against the region’s ‘Practice Engagement Scheme’, which encourages greater involvement of GP practices in commissioning.  

Dr Richard Vautrey, deputy chair of the GPC, said: ‘It is wholly inappropriate to set arbitrary targets for practices to reduce emergency admission rates. It could lead to dangerous outcomes if patients who should be admitted to hospital are not admitted, or their admission is unnecessarily delayed, simply to hit a local target.’

‘It is concerning but not surprising that over half of CCGs are yet to commission services to support practices in this area of work. Even though the enhanced service guidance was only issued in April, the planning guidance directing CCGs to use this £5 per patient was issued in December 2013, giving CCGs plenty of time to get their act together.’

A spokesperson for the Suffolk CCGs said: ‘NHS Ipswich and East Suffolk CCG and NHS West Suffolk CCG are taking an outcome based approach to this NHS England initiative. This will complement the national target for reducing non-elective admissions by 15%.’

Jamie Barrett, head of primary care at NHS East Leicestershire and Rutland CCG, told Pulse: ‘The practices will be assessed on clinical indicators and quality markers set by local clinicians and agreed by the CCG in consultation with member practices.’ 

‘Targets are important to ensure a return on investment that produces real outcomes and improvements – focussed on key areas including end of life planning, care homes intervention and long term conditions (COPD, diabetes and atrial fibrillation) – for the care of older patients across East Leicestershire and Rutland.’

Readers' comments (25)

  • PLEASE HELP ME IM IN PAIN . " YOU CAN STICK YOUR EMERGENCY ADMISSION TARGETS "

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  • ALLERGIC TO TARGETS - JEXT

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  • ‘Targets are important to ensure a return on investment that produces real outcomes and improvements – focussed on key areas including end of life planning, care homes intervention and long term conditions (COPD, diabetes and atrial fibrillation)'

    This is where managers can get it so wrong. Not everything can be measured. More GPs seeing more patients will improve the service we can give. Put the funding there.

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  • Our CCG is doing similar, but no agreed outcome so far. Unless we have a proof-of-concept, how can we determine what is achievable?
    What happens at the end of the financial year, when it is unclear if the same funding will be available?

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  • Good new for DM, practises told send less patient to hospital to get more MONEY, money grabbing greedy GPs!!

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  • We should do whats in the best interest of the patient, not fulfill targets set from NHSE + above.WE SHOULD BE LEFT TO DO WHAT WE FELL IS RIGHT!

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  • Harry Longman

    Hunt: it would be a good thing to improve continuity. Yes. Converts to, we'll limit it to over 75s. And set a target. And have some bureaucracy around it. And spend it through higher level bodies who will make their own rules up. They make them up, add in some more arbitrary targets, which compromise GP professional judgment and patient care. How the world turns. Hope: not this way, but there is a better way.

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  • Who decides what is "avoidable"? Who funds this extra layer of second-guessing?

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  • can't help feeling this story is scaremongering.

    If funds were withheld, surely any practices natural response would be to do the obvious and increase emergency admx, do less Home visits, less clinic time etc. why work so hard to be penalised when this is recycled funding.

    At least go home on time and spend it doing something enjoyable!

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  • This type of target mentality is what the rest of the world faces daily. If you do not make your sales/production target you won't get paid. GPs need to be dragged kicking and screaming into this new world where punctuality and quality of services have improved and become cheaper for the consumer. The privatised utilities and railways also pay dividends to shareholders and take no public subsidy whilst providing the cheap well organised services.

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  • Dear above, There is a slight difference between a target of selling socks and the risk of not admitting Granny to hospital. Death hurts both parties a bit more than sock sales.

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  • Dear Below and now above, I was being ironic! Most of our value cannot be measured. GPs are seen as whinging money grasping b&$7&*^$ when we are trying to gain funding to maintain a good level of primary care services. CCGs should know better.

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  • At £ 3.00 take home pay per consult and £ 70 per year for ever increasing GMS services, we are extraordinary value for money. Pay will continue to fall as we do more and more for the same or less and still go bankrupt. Gosh. I am so glad I can leave this madness.

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  • Anonymous | GP Partner | 28 May 2014 10:48am

    You sound like a GP whose sole aim is the bottom line. People are not trains, power staions, power lines or gas pipes. Some patients need to be admitted to hospital from time to time and this may not be avoidable.
    If youy believe that the utilities and railways provide cheap, well-orgaised services, you are living in cloud cuckoo land.

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  • It all sounds a bit chaotic!
    Is the target to reduce admisions 15% from each practice's last year's total or emergency admissions (remembering that it was a mild, fluless winter without major pressures), from the age-weighted locality/CCG average over x years, or from the regional or National average? Is the reduction confined to the elderly or Avoidable Admissions?
    What if you have already reduced your admissions (following last year's QOF incentives) to the safe minimum?
    And we're now a quarter of the way through the year.
    Nothing changes, does it, when it comes to implementing political sound-bites?
    So glad to have retired already!

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  • Surely they mean reduce INAPPROPRIATE admission.

    As the population become older there will be an natural increase in admission. It is not just dangerous but clinically impossible to buck this natural trend.

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  • Inappropriate admission maybe implies that there was something that the GP could have done instead of admission, such as a DVT diagnostic service or a Local COPD service or maybe a walk in minor injuries unit? When funding doesn't seem to be following work onto primary care, with an ageing population with increasingly complex problems, how are we to actually cut admissions rates? Surely with dwindling primary care provision they will go up, naturally?
    If we are actually given the funding, and if GPs stop getting demonised by the media, we CAN make a difference.

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  • I think you can have avoidable but (clinically) appropriate admission.

    I had to admit a patient with localized cellulitis for IV therapy last week as he has not responded to oral AB and due to the numerous allergies home i.v. was deemed difficult. Yes admission could have been avoided if I could persuade home iv team to go in 4 times/day but clinically it was appropriate to have admitted this patient as he has already have several admission with sepsis from cellulitis in the past!

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  • Anonymous | Sessional/Locum GP | 28 May 2014 12:01pm
    Please read 11.21 and 10.48 will become clear!

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  • Took Early Retirement

    Has no one twigged that GPs NEVER admit patients to hospital? That decision is made by the admitting team. I merely state that I think the patient ought to be seen and the AMU can decide if they need to stay in or not.

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