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NHS Commissioning Board reveals final specifications for new DESs

GPs will have to inform their local area team by the 30 June if they are going to take up the various directed enhanced services for 2013/14, the NHS Commissioning Board said as it released the final details of how practices will be paid for the schemes.

The specifications reveal that the risk-profiling DES will provide the single biggest opportunity for a one-off payment for practices, as it will be worth 74p per registered patient, or £5,175 to an average-sized GP practice.

The board said that GPs will be invited by their Local Area Team to take part in the DESs before then end of June, although practices will also have to agree terms of the remote monitoring DES with their CCG before they can take part.

The biggest changes from the draft specifications released last year are to the remote monitoring DES, that was due to be for patients with one long-term condition chosen by the NHS Commissioning Board.

This has been revised so that practices have to agree an a group of patients with their CCG to introduce remote monitoring and register patients to the scheme this year, in preparation for next year, to gain payments of 21p per patient, representing a payment of £1,478 to an average-sized GP practice.

The most controversial DES - for dementia case-finding - will involve practices opportunistically offering an assessment for dementia to ‘at-risk’ patients during routine consultations. They will then have to refer patients for any specialist help needed, offer a care-planning discussion and identify any carers to gain the 37p per registered patient for the DES, representing a payment of £2,587 to an average-sized GP practice initially, with a further payment later on based on the proportion of patients screened.

GP practices will also earn separate payments for the online access DES, which incentivises practices to introduce online booking of appointments and online repeat prescribing.

Practices will get a single payment of 14p per registered patient, which represents a payment of £985 for an average-sized GP practice, for making online booking available to patients. They will earn a further 14p per patients if they also offer online repeat prescribing, and a further 14p per patient if they can show that a proportion of registered patients have been issued with passwords for accessing services online.

In a letter to Local Area Teams last week, NHS Commissiong Board director of commissioning policy and primary care Ben Dyson wrote: ‘The Secretary of State for Health has directed the NHS Commissioning Board to offer all GP practices the opportunity to provide these enhanced services.

‘Area teams will need to offer these new enhanced services, either directly or (in the case of the risk profiling and care management service) through CCGs, to all GP practice providing list-based primary medical care services under GMS, PMS or APMS contracts. GP practices should be invited to sign up to the enhanced services before the end of June 2013.’

Commenting on the news, the GPC reiterated a warning to GPs to carefully consider the workload and financial impact of taking on any of the new DESs.

GPC deputy chair Dr Rickard Vautrey said: ‘We’ll shortly be issuing detailed information about the DESs to help practices decide which, if any, they should consider doing. We should be clear that this is money that has been taken away from practices and they are being invited to earn it back by doing extra work on top of the work they are already doing. This is not new money and the government hasn’t taken any work away. This means practices that are already struggling under the weight of a heavy workload will have to make difficult choices as to whether it is financially sensible to do even more new work to earn some of this funding back again. Practices need to look at the bottom line not the top when making this decision, and factor in all the increased expenses that they would incur in order to try to achieve these.’

‘Some will depend on what practices are already doing. So for instance the IT DES will be easier for some practices that have already started work on providing patients with access to prescriptions and appointments but will be harder for those that have not. It is also important that CCGs are aware of that this is a limited amount of money for a lot of work as they will have a crucial role in deciding what the final DESs will look like. CCGs should be reasonable and realistic in their expectations of what can be delivered for a relatively small amount of money.’

In further contract news, the Board, NHS Employers and the GPC have now published its joint guidance to GPs for the 2013/14 QOF.

Click here to read the QOF guidance



What will practices have to do?

Agree with their CCG the long term condition that is to be the local priority for remote care monitoring in 2014/15 and the tests they wish to conduct remotely. Register patients to the service.

How much is the payment?

£0.21 per registered patient, which represents a payment of £1,478 to an average-sized GP practice

Click here to read the full specification



What will practices have to do?

Opportunistically offer an assessment for dementia to ‘at-risk’ patients during routine consultations. Refer patients for any specialist help needed, offer a care-planning discussion and identify any carers.

How much is the payment?

£0.37 per registered patient, which represents a payment of £2,587 to an average-sized GP practice. The remaining funding will be distributed as an end of year payment based on the number of completed assessments carried out by the GP practice during the financial year as a proportion of the total number of assessments carried out nationally under this enhanced service in 2013/14.

Click here to read the full specification



What will practices have to do?

At least a quarterly basis risk profiling of its registered patients to identify those who are predicted of becoming or are at significant risk of emergency hospital admission. Work with a local multi-disciplinary team approach to assess and manage those patients in significant need of active case management.

How much is the payment?

£0.74 divided by 365 days, multiplied by the number of days the GP practice provided the services during the financial year, multiplied by the number of registered patients

Click here to read the full specification



What will practices have to do?

Put in place arrangements for electronic communication for booking (and cancelling) appointments and for ordering repeat prescriptions.

How much is the payment?

Two payments of £0.14 per registered patient, and a flat rate payment of £985. This works out as a £2,955 for the average practice.

Click here to read the full specification

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

You can find out more about how to protect your earnings at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers. Richard Apps, partner at RSM Tenon, will be presenting a session on how to maximise your practice income and keep an eye on your cash flow.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (11)

  • I am afraid the timeline seems unduly hasty and is an unusual take on pressure selling.
    The only good news is some of the pricing is clearly some orders of magnetude short of the actual work involved so can be instantly dropped, but some is so unclear that I could not make an assessment of the business case.
    In these uncertain financial times for practices " a bird in the hand is worth two in the bush".
    I may have to decline any DES that I cannot risk evalute fully."Financial jam tomorrow" does not feed staff wages today.

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  • Paying per registered patient for the Dementia DES is not helpful to say the least. As a practice with more than double the national average of over 75's and thus a heavy burden of at risk patients to screen we will get the same payment as a practice at the opposite end of the demographic !

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  • Vinci Ho

    People need to weigh very carefully the actual amount of work entailed ,hence time spent , against the final financial gain . More importantly , this is a trap of diverting attention away from ' main ' businesses as there is always a chance of falling short in 'everything ', not to mention the things matter the most to your patients. Use your time wisely . Money is important but money is not everything.......

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  • So the risk profiling is per day you offer the service & yet sign up by end of June so that us already 1/4 of year gone!! Hopefully our weekly district nurse/ monthly Macmillan nurse meetings will count.

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  • None of them look very appetising.

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  • Which vested interest group thought up this nonsense? Other than the Online access (which is just a case of enabling the systems already present in the system),

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  • Two BIG problems with the Dementia one: (i) the standard questionnaires required are probably unsuitable for the LD patients we are supposed to be targetting; and (ii) the national cap on payments means that the more assessments are done, the less each one is paid. As there is little clinical benefit to the patients, it is hard to see a reason to do this considerable amount of extra work.

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  • 3rd big problem, it has no evidence, this a research project to massage politicians ego, and the memory clinic can't cope, they can't cope now.

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  • The renumeration seems rather small. I suspect time and effort would be far better spent trimming down expenditure.

    e.g. (from my brief scan of the) dementia case finding DES - for the average practice to earn ~£5900. Perhaps (although this is unclear) 192 assessment would be needed - perhaps 20-30(???) cases of dementia may be found and then actioned. Amount of time needed to set this service up, proactively distract yourself and the patient during consultations, and then overload the memory clinic, and then proactively interact with the carer and offer a health check..........???40-100 hours. Number of extra hours worked due to inefficiency created by slowing of other work/consultations due to brain and consultation overload......???50-100 hours. Net work for £5900 = ???90-200hours extra.
    After (40%) tax payment ~£3500.
    After tax payment per hour worked = £17 to £38.

    ............I think I'd rather reduce staff costs, cut my food shopping bill, and continue to try to trim my working day down from the 11-14hour benchmark.

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  • Online access is the most promising development. 7 in 10 people in the UK are online daily, 6 in 10 own a smartphone. EMIS and TPP have smartphone apps. Clogged phone-lines and unnecessary consultations are an avoidable problem.

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