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GPs will have until September to complete bulk of unplanned admissions DES following GPC lobbying

Exclusive GPs will have longer than expected to complete care plans for the unplanned admissions DES, after the GPC and NHS England agreed to amend ‘poorly worded’, and ‘inconsistent’ guidance.

GP leaders have said that they urgently sought clarification with NHS England as the original terms of the DES suggested GPs would have to create care plans for hundreds of patients by the end of June, which the GPC called ‘unfeasible’.

GPC chair Dr Chaand Nagpaul told Pulse that he has been in discussions about the DES requirements and NHS England has given him permission to inform practices they will now have until September to complete the care plans.

It is not yet clear whether a similar agreement will be reached with the contract requirement to notify every patient over 75 of their named GP by July, but Dr Nagpaul said he would provide further clarification on this issuethis week.

GPs have been critical of the new DES arguing that it reintroduces the bureaucracy removed with the cutting of 341 QOF points in the 2014/15 contract, and that it is overly rigid in its requirements and timescale.

The original DES specification outlined that GPs should use an ‘appropriate risk stratification tool or alternative method’ to identify patients to put on the register as part of the DES, which is worth £2.87 per patient - around £20,400 for the average practice.

It said: ‘This register will be a minimum of 2% of the practice’s registered adult patients (aged 18 and over). The minimum number of patients to be on the register each quarter, will be set on the first day of the respective quarter starting from quarter two (i.e. 1 July 2014 for quarter two, 1 October 2014 for quarter three and 1 January 2015 for quarter four).’

The specification added: ‘Personalised care plans should be in place for all patients initially added to the register by the end of June 2014.’

But Dr Nagpaul clarified that this ‘inconsistent’ advice does not mean practices will have to sign up all 2% of the patients by July, and nor have all care plans in place by then.

When Pulse asked whether the specification’s wording would be changed, Dr Nagpaul said: ‘Yes, we’ve advised NHS England, they need to correct any misunderstandings and they said they would be addressing this.’

Dr Nagpaul explained: ‘What the enhanced service wording currently has is this inconsistency.’

Adding: ‘NHS England have given me permission to say [the deadline] is six months… I needed to sort that yesterday because otherwise practices would be under the impression of having to do an inordinate amount work, it just would not have been feasible.’

Dr Nigel Watson, a member of the GPC, chief executive of Wessex LMC and a GP in Hampshire, told Pulse that he had been eager to see the guidance cleared up as it would have required the registering of hundreds of patients by June.

He said: ‘There’s been a lot of concern, and I was one of them[…] For my practice, we would have to have 270 plans in place, and we’d have to develop the scheme – which we’ve done and we had a partners meeting last night.’

‘What was in the guidance was ambiguous, so that’s been clarified.’

Dr David Jenner a GP in Cullompton, Devon and PMS contract lead for NHS Alliance, told Pulse:  ‘The new avoiding emergency admissions DES has just switched all the bureaucracy from QOF and it’s much worse in this DES , if you choose to do it.’

‘The personal care plans, and the templates for them, look really complicated, and you’ve got to enter a code each time you’ve done the plan and you’ve reviewed it.’

NHS England were asked to confirm the changes to the guidance, a spokesperson told Pulse: ’ We are currently discussing this with the GPC who have raised this as an issue.’

Readers' comments (3)

  • It's not feasible even with the extension, the workload is enormous. If we are stupid enough to jump through this giant hoop then future hoops will just continue to get bigger and bigger ....

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  • Bob Hodges

    I no GPs did this DES, appromimately £180m would be retuned to the treasury unclaimed. It would not be 're-invested' into the NHS.

    If the DES would make any difference to patient care, then that might be a bad thing, but the DES won't actually pay for more doctor time spent with patients, it pays for doctors sitting there entering Read codes into computers, and will also result in fewer appointments being available for the 98% of patients not deemed 'high risk'.

    Risk stratification has taught us one thing - that doctors knowing patients reduces admissions and risk. I already know well over 2% of our list very well, and have developed de facto care plans and multi-disciplinary communications far beyond what the DES requires. Doing the DES would reduce the time I have availble to do this properly.

    With 30 years to go until my new NHS Pension 'retirement age', I'm inclined to take the pay cut, which will before tax and expenses amount to less income than an OOH shift per month.

    I quite like my children. I think I might spend more time with them, and less time at work.

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    (from the way I read it):

    Miss the overall year 2% avg per quarter and money is all taken back for the hard work done.

    Target population at risk 2% is re evaluated quarterly. "should the circumstances of any patient change during the year, resulting in their removal from the register, practices will need to identify additional patients .... to ensure 2% is maintained'.

    Producing a plan for a patient is likely to remove them from the 2% target group (if this is evidence based medicine) so we are looking at potentially doing a plan for 8% of the practice or loose the funding for work done.

    It is a significant loss of finance not to do it, but also a significant waste of time if you do the work and the money is taken back.

    Is it another 7% pay cut this year for hard working GPs ?

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