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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)

  • Heard this before "CARE PLANS"- These are not worth the paper they are written on. There is no medical or healthcare staff to execute these plans. Of course there is no social care funding. Mr Hunt's policies is spin and wasteful.

    The care plan for these NHS Managers and their boss- Mr Hunt - change of occupation i.e needs to be sacked.

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  • Until any patient can be seen that day in their practice, this problem will get worse. What is not understood that GPs will not need to work much harder to achieve this. Offering one or two more slots a day, and being flexible when there is flu or pre-holiday inspection syndrome about. Patients should be able to book months in advance. All it is needed it to clear the waiting list, that will be a bit of work, then prevent it arising again. The demand is NOT infinite. There are only that many patients on our lists. Make sure there are 5.5x list size slots available over the year.

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  • Look at patients and we will find a need and sometimes that need can only be covered by hospital care. What's the mortality data for the two cohorts, is the next area I would want to look at. Are the DES patients getting hospital intervention where non-DES are dieing more often, or vice versa. Or does the fact patients and their families now know what to do for medical care, help in lowering the threshold for intervention?

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  • Of course it increased. The patients were looked after better. Relatives saw the care plans in the home , complete with all the different telephone numbers to call , knew that having a care plan means their relative is very sick , in addition these patients do have many illnesses , possibly they need to be in hospital ?

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  • This joke has gone so far in terms of Clinical Governance, wastage of time and funds that it is NOT even funny!

    ...and it took NHSE 2 years and a court summons to figure it out finally!

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  • Fact 1: It has nothing to do with reducing hospital admissions (A&E or otherwise).
    Fact 2: They just need to reduce hospital tariffs to balance the books.
    Fact 3: You cannot ask people to see more patients (improve access) and not expect them to find people are unwell enough to be admitted.
    Fact 4: Unwell people will get admitted (themselves through A&E or to the ward by GP.

    So, the powers that be -- just stop trying and accept the fact that people are actually ill and need admitting. We are not making it up

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  • Took Early Retirement

    It's what happens when you let cockwombles at the DoH make policy.

    As the late Ronald Reagan said, "One of the scariest things you will hear is, 'Hello, I'm from the government and am here to help you.' "

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  • I agree with the colleague who suggested that we stop this now! It is costly, time-consuming for us and not worth proceeding.

    However, even 'failed projects' can be helpful. I do hope that we can extract some useful data from this 'project' that may help deal with the actual crisis in the NHS, including hospital admissions, A&E attendances, GP workload.

    It would be helpful to get a summary of what worked well and what went badly.

    As GPs, AND INDEPENDENT CONTRACTORS, we have no doubt come up with a variety of strategies/interventions. It would be worth finding out what we can learn from.

    We should also learn not to keep repeating expensive, time-consuming projects!

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  • Vinci Ho

    'It is dangerous to be right in matters where established men are wrong' Voltaire

    Either somebody was naive and stupid enough to think a DES was a quick fix to a longstanding , multifactorial and complex problem of A/E admission OR somebody deliberately avoided facing the reality but still tried to earn some brownie political points. Some 'solution' was better than no solution.
    What a waste of money and effort....,,

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  • Another "I told you so moment".

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