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One in seven GPs will refuse to take on unplanned admissions DES

Exclusive One in seven GPs will refuse to take on the unplanned admissions DES, according to a Pulse survey that highlights rising concern over the bureaucracy created for practices by the new GP contract in England.

The survey of 422 GPs found 14% would not take up the unplanned admissions DES, despite this representing a pay cut of around £20,400 for the average practice.

More than half said they would sign up to the DES, but around a third were still undecided as to whether their practice would take it on.

Despite Government and GPC claims that the contract would free up time for practices, two-thirds of the GPs who responded to the survey said the new contract does not significantly reduce ‘box-ticking’.

Many GPs who responded to the survey said the bureaucracy of the new DES and the ‘named GP’ responsibility meant the reduction of QOF had been replaced by another set of paperwork they have to produce to be paid.

The unplanned admissions DES was funded via the retirement of the QOF ‘quality and productivity’ (QP) domain and last year’s risk-profiling DES, and involves GPs providing telephone access to advise on hospital transfers or admissions, case-managing vulnerable patients and reviewing unplanned admissions and readmissions.

Upon reaching the contract agreement with NHS England in November last year, GPC chair Dr Chaand Nagpaul said it would ‘help to relieve workload pressures on GPs’.

A 40-page guidance document on how to implement the DES, including template letters to send to patients, was published by NHS England last week, although the full specification has yet to be published.

The GPC did win an extension to deadlines, as it negotiated a one-month extension for practices to inform elderly patients about their named GP earlier this month.

Respondents to Pulse’s survey highlighted that the new GP contract had not reduced the bureacracy they had to deal with.

Dr Dominique Thompson, a GP in Bristol, said: ‘Loss of QOF just means more time spent on the urgent care DES or other ways to make up loss of MPIG, et cetera.’

Dr Helen McArdle, a GP in Cockermouth, Cumbria, said: ‘Have you read the reduced admission enhanced service? There are about 40 separate boxes to tick and it will not reduced unplanned admissions. Transferring items from QOF to a DES does not reduce box-ticking!’

NHS Alliance chair Dr Michael Dixon, who has previously expressed his support for the Government’s plans for GPs to take on a ‘named clinician’ role for vulnerable patients, said he was concerned about the amount of bureacracy involved in the unplanned admissions DES.

He said: ‘I have concerns about the new DES. A lot of GPs are up in arms saying it is all about form-filling and we have exchanged one bit of bureaucracy for another.’

But GPC chair Dr Chaand Nagpaul defended the contract deal. He said: ‘It’s far too early to comment on this year’s contract, given that many practices are still tidying up last year’s QOF returns, and have yet to work to this year’s changes.

‘Practices will be acutely aware of the mountain of bureaucracy last month in completing three different QP reports, and DES returns on risk profiling, remote care monitoring, online access, as well as a PPG survey. All of these have disappeared for 2014/15, and this year there are also 238 fewer clinical QOF points to chase.’

Survey results

Now the full details of the GP contract deal for 2013/14 have been revealed, do you feel that it will significantly reduce bureaucracy or box-ticking in your practice?

Yes - 11%

No - 69%

Don’t know - 20%

Total - 422

Will you be signing up for the new unplanned admissions DES?

Yes - 55%

No - 14%

Don’t know - 31%

Total - 418

About the survey: Pulse launched this survey of readers on 15 April 2014, collating responses using the SurveyMonkey tool. The 25 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. These questions were answered by 422 GPs.

Related images

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Readers' comments (21)

  • This DES is not going to reduce unplanned admsissions. It had been assumed that GPs send pts into Hospital for the fun of it. I don't think we will be participating in this bureaucratic process. It will engender lots fo anxiety in patients.

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  • The major problems with this DES are
    a. It will not reduce admissions and
    b. Patients will be scared that a necessary admission will be refused to make GPs money.
    It is a disaster.

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  • I suspect the other 6 in 7 are undertaking it to keep their practices viable.

    I haven't met anyone who actually thinks that this will reduced admissions.

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  • Also, I predict the newspaper headlines.....
    " Patient refused admission by GP to bolster income dies..."

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  • Where's the evidence that this DES will have any effect at all?
    We don't send patients in to hospital for the hell of it!
    And we have little influence over casualty attendances with current resources.
    Doing this type of work last year led us to identify only 10% of our patient's casualty attendances as inappropriate, and led to complaints after they took offence to our letter reminding them of other OOH services.
    The ACG tool for identifying at risk patients is a real joy to use. NOT. That is when it is working.

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  • improve a and e facilities than to trothe whole nation at considerable cost which will change nothing..

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  • Vinci Ho

    Flawed but the amount of money could be 'vital' to some practices. The whole mentality of the government about what they want from general practice is grossly distorted simply because of an obsession on A/E admission . This will not change no matter what if the same government is re-elected.........

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  • In other news....
    6 out of 7 GPs vow to do unplanned admissions DES as badly as possible.

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  • The workload, tick box or otherwise, of this DES is significant. Yet, there remains no convincing evidence it will make a difference.
    We are going to have a discussion as to the viability of the DES and how we approach it. Without dropping other aspects of our daily workload, undertaking the DES will have a further adverse impact on work-life balance and quality, something I am getting more concerned about.
    Start charging patients for minor illness attendance, stop giving so much away for free!

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  • So the time i spend tick boxing the new DES and routinely seeing those patients means I will see less acute cases who will instead go to A&E

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