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At the heart of general practice since 1960

The unplanned admissions DES will do just what it hoped not to

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My retirement’s not imminent, so it’s not like I’m really thinking about it. After all, I’ve got another 2,484 days, 7 hours, 31 minutes and – hang on - 45 seconds to go. But initiatives like the unplanned admissions DES certainly focus the mind.

The DES spec has now been unleashed, and those of us who feared the worst have discovered it’s exactly that. A mountain of paperwork, endless reviews and meetings, and a bonkers deadline. Apparently, the release was delayed while the GPC negotiated down the level of bureaucracy – so I can only imagine what the original must have been like.

I’ve no doubt that most practices will take it on, simply because few can afford not to. But it’s not just the paperwork and the pressure which will makes us regret we ever moaned about the lunatic fringe of QOF (good old QOF – remember that?). It’s the fact that this non-evidence based crock of cack is likely to achieve the exact opposite of what it intends to do.

Just reading the specification makes me feel overworked and overwhelmed. So my 98% of non-vulnerable patients are going to get pretty short shrift for the next year. Which means, as far as they’re concerned, I’ll do what’s expedient: send them for X-rays, refer them to outpatients and yes, send them to A&E. Whatever they want/causes me least hassle, because I’m busy building my vulnerability hit list and writing up care plans.

And here’s another irony: those feeling really vulnerable are we GPs. I seriously believe we’re at high risk of admission, albeit to the local secure unit. So I have my own Admissions Avoidance Plan, which I’d like to propose to the DH. Specifically: LEAVE US ALONE TO GET ON WITH OUR JOB. You might be surprised how well we do it.

So: 2,484 days, 7 hours, 26 minutes and 30seconds. And counting.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield

Readers' comments (8)

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  • Fully agree.
    As soon as you offer on the day appts to those in the list , ghiven time if finite in GP world someone else has less time.

    70%-90% of A&E admissions come from new random emergencies and not reattenders. However reattenders do so as either other services (social/carer support) have collapsed or in rare case they has enduring menatl health problems which makes them health seeking.
    I can images the neurotics ****fest- "Can you see me today or I will attend A&E and say you wouldnt see me TODAY/NOW for this mole which has been there for umpteen years".
    Welcome to the new world
    When we introduced a special number for reception for medical emergenmcies the first call that came was "breast implant scare". Says it all.

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  • I still haven't worked out the bit that said paperwork would be cut and we would have much more time to spend with patients. The only things I see getting cut the the parts that were achieveable relatively painlessly to be replaced by a mountain of unachieveable, time consuming nonsense which is not use to anybody.
    TC - will you make yourself known at Pulse Live this year? I imagine many of us would be pleased to meet you. Any chance after retirement you will become the government adviser for health and talk some sense into the politicians? Dont think I can wait that long.

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  • Dr Mustapha Tahir

    Tony, I totally agree. This is the most bizarre DES ever! I'm surprised you can afford to hang on for more than 2,000 days more. That's another 6 years of more DESs!! I admire your commitment!!

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  • So, your writing all 172.5 care plans yourself Tony? What are your Practice and Community Nurses doing to help??

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  • My practice nurse and DN colleagues are too busy with the day job to take on this additional work - as am I but the buck always stops at the GP.

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  • The community nurses are already working flat out in my area too and have more than enough paper work of their own without us expecting them to do ours for free. If only sense would prevail and more funding was given to have more community nurses to visit vulnerable patients rather than paper chasing DESs which will achieve zero.

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  • can we drop a hydrogen bomb on the department of 'health'?nothing would do more to improve the nhs..sorry about the collateral damage..though taling out parloament would be useful also!

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder