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GP funding to reduce unplanned admissions withdrawn after targets missed

CCG leaders have prematurely halted a local QIPP scheme for GPs to reduce unplanned admissions, after it failed to achieve its targets.

The scheme was commissioned for the whole of 2013/14 by NHS Basildon and Brentwood CCG, with a target to reduce unplanned admissions to save £550,000. However, seven months into the scheme, in November, it was found to be 32% short of its target.

The scheme, which was rolled out as part of the CCG’s QIPP plan, had been intended to run until 31 March, but Pulse has learnt it ceased on 31 December, with one quarter of the funding withdrawn.

The scheme had focused on the creation of clinical pathways and practice-to-practice support to reduce admissions to hospital, and aimed to ensure the CCG could achieve its targets for its quality premium.

CCGs have a quarter of their quality premium tied to reducing avoidable emergency admissions, a larger proportion than any other area.

In a letter announcing the cessation, the CCG wrote: ‘At the clinical executive group on 28 November it was agreed that the QP+ scheme would be stopped with effect from 31 December 2013 because of how far from target the current achievement is.’

‘As you’ll know the QP+ scheme comprised of two parts, the facilitation fund and the achievement fund… The facilitation fund was to pay for the development of a clinical pathway and actual activities practices undertook in support of QP+ as set out in each of the locality plans. As the scheme will cease on 31 December and has run for nine months of the year, the available fund will therefore be reduced by one quarter.’

Local LMC representatives said they were not well-informed enough to comment but were ‘not surprised’ the scheme had been canned.

The cancelled scheme comes as GPs across England prepare to undertake a similar DES to reduce unplanned admissions from April, even though experts have questioned whether the new DES will achieve its aims.

But GPC deputy chair Dr Richard Vautrey said that the DES had ‘learned some lessons’ from previous failed schemes in the past.

He said: ‘None of us are under any illussion that [the new DES] will be the only thing that will impact on reducing unplanned admissions. This is a complex picture and general practice only has one part to play.’

Readers' comments (9)

  • Vinci Ho

    So what does tell you about the truth? Evidence after evidence had supported how little GPs can do to reduce these admissions to the level agent Hunt et al. had been fantasising .
    Of course , it is so 'easy' and cheaper to throw these DES to GPs to accomplish mission(s) impossible . Problem 'solved'( well, at least to those voters who do not know the inside stories)..........

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  • Well just today (I'm oncall on Monday you see),

    I had a patient who turned up late then after declining to see him, went home and wife insisted on a home visit for cough which he had for 4 weeks
    Then another who insisted was urgent and I asked him to come straight away and wait so I can see him in between patients. He asked me what I I finished and turned up just before closing so he didn't have to sit and wait.
    Another booked an emergency appointment to have a blood form. When I pointed out this isn't an emergency and I reserve the slots for ill people, he told me in his eyes it is an emergency and I was wrong to decide what an emergency was (sorry, I assumed my medical training & 14 years of experience might have allowed me that judgement).
    And countless coughs and loose bowel which were emergencies in dire need of antibiotics - presumably "nurse, give that stat" kind.

    So anyone who thinks GPs on their own can make a difference is rather mistaken. If the government wishes to make a difference it needs to start with public education, installing a sense of duty to the society, placing barriers to free medical treatment, and giving health care workers powers to say "no, that's not reasonable" without fear of a complaint. Will Mr Hunt got the guts to tell the truth - of course not!

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    1. Do as the patient says, the patient is king.
    2. Control and force the patient to do as we deem fit.

    Which is it to be then?? Talk about mixed messages.....

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  • Unplanned acute hospital admissions will never be controlled unless OOH services are up-graded.Demographic changes will inevitably lead to increased acute life-threatening illness and offering to pay GPs bankers bonuses to try, Canute-like, to reverse this tide is useless and ethically questionable.

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  • well said both 7.11pm and 8.11pm. that is exactly right. patients asking/demanding for the unreasonable and stating "they know their rights" and Gps being told to cut prescribing, cut referrals! we are caught in the middle. no wonder so many are leaving!

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  • I just try to do what is right by my patients. This is what we are sworn in to do. I will tell patients if ivthjnjvyheir emergency appointment is unreasonable and hope that they won't 're-offend' but in truth, it really does need a change in public expectations if we are to manage the NHS in the years to come otherwise collapse is inevitable

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  • Can 7.11pm explain the relevance of of these remarks to the item under discussion? How many of these "rubbish" patients required admission to hospital and how many were actually admitted. By all means have a moan about the inappropriate use by patients of emergency appointments, with which we would all agree, but don't try to tie this into reducing hospital admissions. I have no doubt that, had you thought that anyone required hospital admission, you would have referred him/her.

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  • Oops, that's my fault, I read "unplanned admission" as "AED attendance" but looking back on the article I misunerstood.

    You can tell I had a bad day :(

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  • Hang on! support of 7:11pm's initial posting I'm afraid I disagree with the suggestion this has nothing to do with emergency admissions…its got everything to do with emergency admissions!

    If GP appointments are jammed up with irrelevant minor self limiting illnesses then there are far less appointments available for the genuinely ill. If you are genuinely ill - maybe on the way into hospital if you don't get seen quick - you don't have the time or energy to be obsessively calling your GP who's taken up with dealing with 'emergency' blood form requests, you might just be tempted to call 999 or just go to a&e instead.

    We absolutely need to be educating the public about appropriate use of GP appointments and what is and is not an emergency and to me it certainly is relevant to discussions of how to reduce unplanned admissions to hospital.

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