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Be careful, DES is out to get you

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We know DES, of course, but he’s changed. He’s already king of the PPG and last year, he took on dementia.

This year, DES fancies having a pop at unplanned care. More specifically, he wants to stop our patients having admissions that are unplanned. These aren’t the acute MIs and thrombolysable CVAs, which even in 2014 are still regarded as plausible reasons to attend the emergency department. No, these are the more chronic issues which can be managed better by us GPs, the newly-named and likely-to-be-blamed. 

In a nutshell, DES wants us to stop the re-offenders: the hypochondriacs who pitch up with their IBS, the frail well who fall, the ‘trivial’ overdosers. 

Let’s drill into some detail then, helping you and your practice to earn your £2.87 a patient:

  1. Get a dedicated phone number. The on-call GP needs to be contactable by paramedics, ED doctors and care home staff. In our practice, we have a surgery phone number, and the receptionist can contact the on-call through the internal phone line. Cutting edge stuff! I hope DES won’t mind if I don’t literally answer the phone myself…

  2. Identify the 2% most culpable over-18s. (I can think of 1% off the top of my head). You need to use a ‘risk stratification tool’ to help. Try this short patient questionnaire: How many times have you dialled 999 or 111 in the last four weeks.? How many times do you intend to dial 999 or 111 in the next four weeks? 

  3. Get the culprits on a register (DES loves a register) by the end of July and write to them with their named accountable clinician. (You can’t assign patients to the HCA, phlebotomist or a locum GP, but good thought). Create a ‘personalised care plan’ for each patient. DES says this must be ‘written’. Give them your mobile number so they can phone you whenever their index finger starts hovering nervously over the number 9 button on their mobile’s keypad.

  4. Review your patients every three months. Use Read code dNd999/111 for ‘unplanned admission personalised care plan quarterly re-planning plan’. When you’ve done it, tick it.  Make sure any action points you’ve agreed with your unplanned admission patient are shared with the CCG. DES believes in the value of sharing.

  5. Meet for coffee with your colleagues at ‘regular’ intervals and discuss your cases.  The frequency of these meetings can be determined by the practice, but ‘annual’ may not cut it.

  6. Audit and appraise, frequently and thoroughly. Tell DES you’re doing it too.

On the face of it, not a huge chunk of work, is it? Much of this stuff is about registers and re-jigging.  Do it well, which we hope to, and your practice is in line for a decent windfall come next April. 

A word of caution though. The 2% list this year nets £2.87 a patient. Will the threshold be 3% next year and 4% for 2016? If so, there’s no way the cash will follow the centiles. DES treads a well-worn path: throw GPs financial hook, make them tow the (apparently beneficial) line, increase parameters (but not money), encourage adverse publicity, then sit back and watch them sink.  

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.

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