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Gold, incentives and meh

GPs to be paid £30 per patient to lighten consultant case-loads

Exclusive GPs will be paid £30 per patient to go through hospital lists and identify those that could be discharged and managed in primary care, in a radical CCG plan to cut the case-load of consultants and save cash.

In a QIPP initiative hoped to ease the pressure on hospitals and generate savings for the NHS, participating GPs will receive a one-off fee of £30 per patient from for carrying out a review of all patients being managed by the diabetes and respiratory medicine teams and seeing if they could be discharged.

The scheme - run by Tameside and Glossop CCG - and due to begin in September has been expanded after a similar intiative run last year for cardiology patients cut lists by 19%.

The CCG hopes to save £42,000 - and an additional £273,000 after reviewing all patients by re-commissioning the diabetes service - with the scheme at Tameside Hospital NHS Foundation Trust, one of the trusts placed under ‘special measures’ following the review of mortality rates conducted recently by NHS deputy medical director Sir Bruce Keogh.

The scheme comes after GPs were called into hospitals and other secondary care facilities to register patients and treat them on wards and demonstrates that CCGs are exercising their commissioning power to pay GPs to shift more care in the community.

A spokesperson for Tameside CCG said the response from GP practices to the scheme had been positive.

She said: ‘We ran the same exercise with our cardiology follow up outpatient list in 2012, resulting in almost all of our GP practices engaging in the project which led to a significant impact.

‘We have had a favourable response from our member practices to the diabetes proposal so far, and expect a high response rate once the work begins. We are also in discussions to look at similar projects with our respiratory and ENT patients.’

A QIPP report from Tameside and Glossop CCG, seen by Pulse, said: ‘This follows a similar review in cardiology during 12/13 which saw 19% of patients discharged back to the GP.

‘This review of diabetes precedes the commissioning of a new diabetes service to ensure only appropriate patients are transferred over.’

Dr Shane Gordon, chief officer of NHS NE Essex CCG and a GP in Colchester, Essex said it made sense for specialists to be left only with the most difficult cases.

He said: ‘It’s about using the specialists for the group of patients that most need it. If their waiting rooms are clogged up with patients that could be seen in primary care then moving those people who are less complicated to be cared for by their GP means resources are being used efficiently.’

Dr David Jenner, the general practice network lead at the NHS Alliance and a GP in Devon said it was a ‘reasonable’ idea, but warned GPs would need ongoing support to care for the patients discharged back to primary care.

He said: ‘We’ve done something slightly different locally by introducing specialist diabetic nurses and virtual clinic with diabetologists, so there are different ways of cracking an egg.

‘I’d also review what support GPs need to look after the patients. What primary care will need is something recurrent as well as a one-off fee for the review. They should negotiate a fee for taking back the patients when they can, and the ongoing support to make that happen.’

He added that while this could work for patients with diabetes, there are certain areas like rheumatology where it is more integral the patients are managed by specialists.

Readers' comments (23)

  • How much does a hospital admission cost PER night? When I was a medical student it was quoted to be around £300 per night. So £30 is very little indeed - and since there is no capacity in general practice at all, how are these 'borderline' patients going to be looked after? And does our medical indemnity cover us for this work anyway?

    This seems like a rather bizarre idea.

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  • Surely it would make more sense for money to be spent on training up GP's i areas where they may lack confidence so these cases can be managed in primary care. a more structured education based approach would have a greater long term impact, as well as improving quality.

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  • I'm assuming this is OPD and not in patients.

    It's a good initiative as some patients keeps on going back to OPD for reasons I cannot understand. But it doesn't mean there is no justifiable reason - it may sometimes mean there are areas out side of GP's knowledge which the specialists has, and GPs "discharging" patients from clinic may lead to mismanagement.

    I wonder what the re-referral rate for these patients are in 12-24 months?

    It is of course true that some of us could do with polishing up on certain areas of medicine!

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  • Peter Swinyard

    Similar scheme in Swindon last year looking at A&E attendances and OPD follow-ups to see what could/should be repatriated to GP. Was called ROPE (which I think meant Review Of Patient Episodes or some such) and we got money for old Rope (but not £30 a head!!!!). A useful exercise nonetheless.
    As GPs have become the main generalist physicians, it does make sense for some work to be repatriated to general practice but the premises and GP time need to be liberated to make this work. We need to stop asking athletes how many hours they spend gardening and asking diabetics if they eat well and get some headroom to do what we are expensively trained to do, which is not ticking boxes on computers. When I trained as a GP, there were effectively no computers in general practice at all!!! Patients still seemed to be cared for.....

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  • I thought all the GPs were overworked just keeping up with practice business and facing burnout and too much stress to manage any more work. Thats certainly the impression you get reading the articles and comments on this site. Or does that miraculously disappear when cash is dangled under their noses?

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  • @anonymous 12.35pm - in case you hadn't read properly - mainly GPs are saying they CANNOT take on more work on this feed, especially without the resource and training reqd. Pls don't belittle our ethics.

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  • @1235 - I am not certain of the entire circumstance - but suspect this money may be instead of another source of income (?a different LES). So the choice is between doing this and increasing workload or reducing doctor time and increasing workload for those remaining. If it is instead of a different LES then practices would not longer have to do that work, but most of the time it is expected that they will.

    This is why there is burnout not a sign that there is capacity in the system.

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  • This is bizarre. Hospital consultants have increased in number by 49% compared to 19% for GPs.

    So we are meant to free up time for consultants when we are stretched seeing our own patients.

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  • I find these financial incentives deeply concerning, and I wonder how the CCG would reassure patients that the financial benefit to the GP would not affect their decision-making. It would seem to contravene GMC guidance, which states that:

    'You must not allow any interests you have to affect the way you prescribe for, treat or refer patients.

    You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You
    must not offer such inducements.

    You must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must tell patients about your fees and charges.'

    One could argue the the CCG should be reported to the GMC for offering these inducements.

    It sounds very arrogant to assume that a unilateral decision will be in the patients interest. It would be so much safer to work in conjunction with consultants and patients, to ensure that safe discharges can be made. This is so much harder, given the commercial barriers we are now trapped by.

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