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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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