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The waiting game

Unplanned admissions DES is failing to reduce emergency activity

Exclusive GP practices that devise care plans for the majority of their most vulnerable patients have higher rates of unplanned admissions, a Pulse analysis of official figures has shown.

Data on the Avoidable Unplanned Admissions DES, published by the Health and Social Care Information Centre last week, showed that practices that put most of their patients on care plans had a higher rate of unplanned admissions than those who put few patients on care plans. 

The findings undermine the objective of the DES, which is worth £20,000 for an average practices and aims to reduce the number of unplanned admissions to relieve pressure on hospitals.

The GPC said these data prove there was ‘no link’ between the DES and reducing unplanned admissions.

Under the terms of the DES practices must identify the 2% most vulnerable patients on their list and devise individual care plans for them.

NHS England’s DES specifications said: ’This enhanced service (ES) is designed to help reduce avoidable unplanned admissions by improving services for vulnerable patients and those with complex physical or mental health needs, who are at high risk of hospital admission or re-admission.’

But Pulse’s analysis of HSCIC statistics has suggested that those that give more patients written care plans under the DES are more likely to have higher rates of emergency admissions.

Pulse examined the practices that put more than 80% of their most vulnerable patients on care plans, and compared them with those that put less than 20% of their patients on care plans.

It revealed that:

  • 7.2% of patients in those practices that had devised care plans for >80% of their patients reported an emergency admission in the first quarter of 2015 (5,312 practices).
  • Only 2.2% of patients in practices that devised care plans for >20% reported an emergency admission in that time period (553 practices).

Professor Martin Roland, professor of health services research at Cambridge University and a part-time GP in Cambridge, said it was difficult to draw conclusions from ‘bald data’ but said it could be ’that those with a high proportion of care plans have sicker patients’, for example many nursing home patients.

He also highlighted a BMJ paper from earlier this year which concluded there was ’limited potential for reducing emergency admissions’.

HSCIC advised against practice comparison on the basis of the data ’without taking account of the underlying social and demographic characteristics of the populations concerned’.

But GPC deputy chair Dr Richard Vautrey said the figures confirmed what most GPs think - that ‘there is no link between the DES, care plans and emergency admissions’.

He said: ‘At a time when GPs and their practice staff are under ever increasing pressures, the DES is just adding to bureaucracy and in many ways is getting in the way of practices being able to spend time meeting the real needs of their most vulnerable patients.

‘That’s why we’ve agreed to discuss ending this enhanced service next year and instead reinvesting this much needed resource in to core practice funding, so freeing up practices from unnecessary bureaucracy and box ticking and enabling professionals the freedom to do what is right for these important and often complex patients.’

DES ’has not been effective’

LMCs Conference 2015

LMCs Conference 2015

At last year’s LMCs Conference, GP leaders voted in favour of a motion which called on the Government to abolish the enhanced service.

The motion declared the DES lacks evidence; has not been effective in its aim of reducing hospital pressures; has distracted GPs from caring for patients; puts GPs in medico-legal danger; and ‘was always destined to fail’.

Following this, the GPC has called for it to be abolished, and are discussing the issue as part of negotiations for the 2017/18 contract.

But, despite this, NICE last week called for all patients with comorbidities to be put on care plans in its new guidance on multimorbidity.

Readers' comments (38)

  • It's targeting the patients most likely to be admitted so why the surprise when they are ? It's another misadventure based on the premise that Gp's are not doing their job properly but will somehow "up-their-game " if paid to do so . Greedy GP's !

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  • Wow - they finally figured it out!!

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  • it would be funny if it wasn't all so tragic

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  • No! surely not! Next...

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  • BUT the unplanned admissions DES DOES reduce GP and PN availability as they have to sit through meetings reviewing patients and spend precious time writing then reviewing care plans (often for people that don’t need them to meet this daft 2% target – we have a lot of students so 2% of our list 18 years is just plain wrong). Huge amounts of admin time is also taken up as we trawl through discharge letters and IPIL. Why the DES is continuing for another year amazes me. Surely it could be axed now and the money spent on the “We’ve got a pot of cash so let’s use to fund more GP/PN appointments DES”

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  • Yep entirely expected, we didnt do the DES but have documented evidence actually decreased admissions to hospital, decreased A/E attendances and decreased A/E attendances sent on to front end GP. Pointed this fact out to the "powers" so thought we might get some aknowledgement?

    Absolutely not! Says it all

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  • I would go as far as saying that this DES did the exact opposite of what it was trying to achieve. It INCREASED admissions. I fine example of how improving access only increases demand. When will they get it?

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  • Is that because GPs are so busy filling out care plans rather than caring for patients?

    Or does this merely indicate that practices who didn't engage with this nonsense were those who refuse to put the pound above the patient?

    Don't expect such evidence to stem the tidal wave of expectations for more care plans and advanced decision nonsense from the DH coming our way though.

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  • why is a study needed to prove this. it is obvious that this will be the case if you have people being seen over and over again by multiple clinicians that they will get over investigated, over treated and likely over admitted as well

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  • One of the stupidest DES's ever

    It seemed complicated at the start but in the end paid a fortune for us doing very little

    Try and come up with something even more ridiculous next time Hunt, in time for the election

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