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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)

  • WHEN THINGS GO WRONG gmc will be sympathetic ?????

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  • Dear CCGS

    THE GMC Good medical practice 2013 states that 'You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients. You must not offer these inducements.'

    Err...? I think it's pretty clear. To pay only if referrals are reduced is both unethical and illegal

    And people will die avoidable deaths

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  • Some patients need to go to hospital and some under 75 need specialist care, surely the role of the GP is to care for the sick, regardless of age?

    It is difficult enough now to get an appointment age of GP's because GP's cannot close their lists without being penalised, there just aren't enough GP's to cope with the workload.
    So while the over 75's are getting all the attention from GP's, who is going to look after other patients?

    In my area we have more nursing homes than shops and pubs, and staff find it easier to call out the GP rather than make the effort to bring the able bodied person to the surgery.

    I wonder who is ensuring NHSE is doing their job before they get paid?

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  • I have only a max of 6 hours sleep and I can't afford to lose more over idiotic rationing of services and putting patiens to risk for some measly bucks that won't add up. I try to provide the best care and happy to do it without the CCGs breathing down my neck. So, keep the change as Kevin would put it:)

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  • @10:48 I can see that you have lost touch with reality on the ground my dear colleague. If you want to drag your colleagues 'kicking and screaming into this new world' that is fine. But are you really talking of 'improvement in quality of services and 'dividends for GPs'?? Never heard anything so stupid and abstract. Maybe you would like to put a a name to your post so we know whether you are really a 'GP Partner' and from which part of the planet you descend. Kind regards

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