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Independents' Day

GPs to oversee all vulnerable patients under emergency admissions DES  

GPs will be responsible for case-managing and preventing hospital admissions - through direct phone contact with emergency providers and patients - through a new DES.

The new DES will be funded through the abolition of the quality and productivity domain of QOF and will mean GPs have to improve services for patients with complex health and care needs, who may be at high risk of unplanned admission to hospital’.

This will mean all vulnerable patients will be ‘proactively case managed’ and have a named, accountable GP co-ordinating their care.

The service will require GPs to provide ‘timely telephone access’ to relevant providers to support decisions relating to hospital transfers or admissions, in order to reduce avoidable hospital admissions or A&E attendances.

They will also have to improve access to telephone or, where required, consultation appointments for patients identified in this service.

The DES will also require that GPs review and improve the discharge process, sharing relevant information and whole system commissioning action points to help inform commissioning decisions and undertake internal reviews of unplanned admissions/readmissions.

Funding for the service comes from the retired QP domain of QOF worth 100 points, as well as additional £42 million from discontinuing the DES introduced this year on risk profiling.

GPC deputy chair Dr Richard Vautrey said: ‘Practices need to ensure that if somebody from A&E is treating one of their patients and wants get through to the practice to find out what drugs they are or what happened in a consultation earlier on, there is a swift way of that clinician being able to contact practice.

‘That might mean providing a specific number for A&E or a more dedicated ex-directory line, potentially ensuring there is prompt access for such situations.

‘This applies to the contract so has nothing to do with out-of-hours. This is about the responsibilities for the practice in terms of their contract between 8am and 6:30pm.’

NHS England said GPs would need to offer patients same-day telephone consultations and provide other healthcare professionals with a direct line, but there would be no need to deliver 24-hour access.

A spokesperson told Pulse: ‘There is no 24-hour helpline requirement in the contract. The new enhanced service on reducing emergency admissions includes a requirement that the practice offers a dedicated telephone line.  

‘Practices will provide high-risk patients who have urgent queries with same-day telephone consultations or with follow-up arrangements where required.

‘The second dimension is improving availability for other healthcare providers such as A&E clinicians, ambulance staff and care and nursing home staff, who will be able to use a dedicated ex-directory or bypass number to gain convenient access to the practice to support decisions relating to hospital admissions and transfer to hospital when vulnerable patients present.  This will apply during contracted core hours.’

Readers' comments (18)

  • But surely Dr Vautrey we will be responsible for these patients 24/7 anyway as they will be in the vulnerable/at risk group so we can be called out of hours about them and this will be a contractual responsibility will it not ?

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  • It would be so much better if hospital computer systems were compatable with GP systems. The hospitals already manage timely access for drug history etc - it is called the telephone.

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  • What if it's a weekend or the doctor that knows the patient is around.
    Very I'll thought through scheme again

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  • If a patient with heart failure has a sats of 84 % and. Boba sale creeps with increase JVP.
    How would we prevent admission of this patient.
    Another scheme to cover the Governments invompetence.
    They've not spoken about the botched 111 service.
    What it a patient comes in at 12 midnight.. Do they expect a GP to be up then .

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  • God, will the entire GPC team wake up to the reality!?

    First of all we will be loosing income unless we take part in this as it is funded by the QoF money.
    Secondly, the suggested actions here will require a lot more work by GP then the QoF domains.
    Thirdly, how will the secondary care know which GPs are taking part and which are not?
    Forthly, some of the infrastructural change will cost money in itself (new telephone line anyone?)
    Fifthly, during my 10min consultation (average consultation time 5 years ago was >11min), I don't have the time to talk to someone else. And my surgery runs for 3 hours each session.
    Finally - where are we going with this? As already mentioned this is paving the way for GPs taking on 24/7 care at no extra funding

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  • Patients don't become vulnerable at 75, anyone can become extremely vulnerable when they have multiple problems, regardless of age.

    Are the NHS telling us that if we are under 75 and vulnerable, nobody will care or our care will be of a lower standard?

    My GP look after me regardless of my age and vulnerability, when I face a crisis, he is there to support me, exactly what if it that the these people expect GP's to do, become lodgers when someone reaches the age of 75?

    I feel they should leave GP's to decide on what their patients needs are, they have built up a good relationship with us, and we with doctors we know and trust!

    I don't want to need to ask a stranger in a pharmacy to examine me alone, in a small room at the back of the shop. I do not want, and never have needed my GP to work 24/7 or fro my surgery to be open all hours.

    The sad thing is all these changes are being made by 'pen pushers' who haven't a clue what a day is busy surgery really is like. I bet most of them have private care anyway!

    Leave GP's alone, they are the NHS, they are anything but stupid, they know our needs better than anyone sitting in an office, a person that has never even met me.

    Why all the GP bashing anyway, if they all resigned there would be no NHS!

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  • 'GPs will be responsible for case-managing and preventing hospital admissions - through direct phone contact with emergency providers and patients '

    Trying to case manage patients to avoid unnecessary urgent admissions is useless if we cant get hold of our secondary care colleagues who are also involved in the care of certain patients! It takes days if not weeks for some to call back (sometimes no response)- in that time the patient has had to be admitted urgently when a possible planned admission could have been organised with better direct communication. Everyone needs to be involved in co-ordinated patient care not just GPs.

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  • Those that think this is a return to the 'old-fashioned GP' style of medicine are misguided in my view.
    Back then those GP's were able to do what they could in the community setting knowing full well that in general they had the sympathetic local DGH to refer onto who would accept the patient willingly for further care. The pathway was centred on patient need. The pathway now is based on the Exchequer's need with the 'best pathway' the cheapest. That's where the GP (surprise) comes in. Bottomless 'named' responsibility added in for good measure so the lawyers, accountants, politicians and patients know who to aim fire at. Publish their income as well and you've got a rock and a hard place.

    Hunt and his cronies will be dancing down the corridors of the DoH at the ease in which they turned the Profession inside out, given all the responsibility and no real power. There's loads more to come by the way.

    The solution for the Exchequer lies within distant off-shore tax havens, robber barons and bankers, creative accounting and the unaccountable power of multinational corporations to influence politicians. If the
    Exchequer had his legitimate 'take' from that lot, health and all the other cash-strapped public sector services would experience the renaissance they deserve.

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  • maybe i am missing something: We already offer same day appointments ( in person) or via telephone if vetting requests for home visits to all not just the >75. We have an emergency phone number that does not switch off during lunch or until 6.30pm. A&E can already get this information by calling us on the phone and we fax over patient summaries, or we speak to the doctor if they ask us to! We dont have fixed patient lists but we all have patients that 'belong' to us and will always choose to see a specific Dr if they are working that day ( we are all part time) and run a buddy system for when people are away. Ar we not doing everything already or have I missed something out? Admission prevention would be far easier if we had timely out patient appointments or telephone access to consultants for advice, not the ST3.

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  • Don't need a contract to tell highly educated people they can use a telephone....

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