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Practices to case-manage patients at risk of hospital admission, under new DES

GPs will have to go through their practice lists to identify and case manage patients who are at risk of unplanned hospital admissions, under the terms of a new DES released by the Department of Health today.

The DES aims to ensure that frail older patients and those with mental ill health are kept out of hospital, but will mean practices will have to carry out regular risk profiling of patients to identify those at significant risk of unplanned hospital admissions.

Under the draft terms of the DES published today, practices will have to agree to case manage a proportion of these patients with the NHS Commissioning Board in order to the number of unplanned hospital admissions.

A nominated lead professional will be responsible for each patient being case managed and they will have to carry out a review of each patient’s case management of their clinical and care needs ‘at a specified frequency’. Practices also need to hold regular multidisciplinary integrated care meetings for the case management of each patient.

The DES will be funded by the cash released from the abolition of the organisational domain of QOF.


Readers' comments (9)

  • Thank goodness I retire in April after 30 years working in General Practice.

    Good luck to those left behind!

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  • What happens if patient does not consent to their info shared with thirds parties/MDT's?

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  • along with their annual copd, diabetic, cvd and dementia reviews and 6 monthly medication and bp checks. how much more proactive can we be!

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  • I've just about had enough ....
    The problem is time to do all of this. The time does not exist. Therefore we are being set up to fail...

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  • This is easy.........GPs in the North East have been doing this for some time now using RAIDR which has a risk of admission (CPM) tool.
    Contact us for more information on RAIDR on 0191 217 2547.

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  • I wonder if there is any evidence that this sort of case management reduces admissions? I thought the evidence was that it didn't- does anyone know? If so we are definitely being set up to fail. We are already using Long term conditions matrons for our high risk patients and it doesn't seem to have reduced admissions anecdotally anyway

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  • As a PRactice Manager for over 20 years - I did love my job and could not contemplate retiring - I've changed my mind! Show me the door!!

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  • PARR has been discontinued.
    Can someone point me to the tools integrated into GP systems which would allow this to happen?
    I assume the risk assessment tools would have to be acredited/validated - by - someone or other?
    2 weeks to go - when will practices be expected to take up - or not - DESs where the requirements (and tools) are still being developed?

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