Exclusive Practices will not get paid for the unplanned admissions DES if they miss any single aspect, despite previous reassurances from local area teams that they will be given leeway if it benefits patients, LMCs have warned.
In a letter to area teams, NHS England has said it is important that regulations are applied to the letter because the DES will ‘undoubtedly be scrutinised’ as it contains such a large tranche of funding.
However, GP leaders have pointed out that the deadlines for the DES are particularly strict – and have been compounded by a delay in publishing codes for completing care plans – and that they will have to ‘cut corners’ to ensure they get paid on time.
Local leaders have further warned that they had previously been given reassurances that they would be given leeway when taking part in the DES so they ‘can do this properly’.
The DES, which is worth £20,000 for the average practice, requires practices to produce care plans by September for the 2% of patients on their practice list who are most at risk of unplanned emergency admissions.
GPs have expressed concern at the paperwork required under the DES, with a Pulse survey revealing that only 11% of GPs thought it would reduce the amount of ‘box-ticking’, with NHS Alliance chair Dr Mike Dixon criticising it as ‘exchanging one bit of bureaucracy for another’, while one in ten practices have refused to take part, despite the significant funding at stake.
The DES requires that any patients who are added to the risk register must be given a care plan within one month, and GPs will be expected to undertake monthly reviews of their risk register to check whether they need to take any action to prevent unplanned admissions – for example, on the basis of whether patients requiring multidisciplinary team input are receiving it, and whether the practice is receiving appropriate feedback from the district nurse team.
But the letter from NHS England, dated 16 July, from its head of primary care policy, Deborah Jaines, says that there will be extra scrutiny to ensure the DES has been correctly carried out.
It says: ‘As I am sure you will appreciate, at a national level, a significant amount of funding is associated with this scheme and all elements were carefully agreed with the Government and negotiated with the GPC. As such, the uptake and performance against this service will be undoubtedly be scrutinised. So it is especially important that all area teams are applying the same rules for funding.’
‘A number of you have suggested that the CCGs in your area are already doing something very similar – or they have asked whether the scheme can be supplemented with local CCG funding to cover a greater cohort of patients. Of course we welcome this approach. However, the scheme for which the national funding is available must remain intact and cannot be compromised nor can elements of it be ‘traded’ for the suggestion that more patients might benefit if this were to be allowed.’
Bedfordshire and Hertfordshire LMC chief executive Dr Peter Graves said that this letter forced his local area team to change its stance.
He told Pulse: ‘We’d had assurances that there would be an element of leniency with the deadlines.’
‘GPs want to do it properly and professionally, to get the maximum benefit for their patients. So let’s just be a little bit lenient with the deadlines.’
‘And the letter says they have absolutely got to run this by the letter of the specification, so that will mean GPs will end up having no option but to run this as a tick box exercise.’
‘We’ve just got no option but to cut corners, which we don’t want to do. We want to do this properly because this is a particularly vulnerable group of patients.’
In London, Dr Tony Grewal, Londonwide LMCs’ medical director told Pulse that it had asked for some movement on deadlines after problems getting information from CCGs, but that NHS England had been firm on the deadlines.
Dr Grewal told Pulse: ‘We know that they are applying the letter as well as the spirit of everything. So if you’ve missed the dot off an “I” they’re not paying.’
‘Again there was some difficulty with this one [unplanned admissions], over generating the lists of vulnerable patients which practices had to take some action over -because not all CCGs were able to deliver those to practices in time.
‘We asked them to move the deadline, and got the usual response from NHS England – “no”.’
And the GPC’s deputy chair Dr Richard Vautrey explained that practices were used to NHS England ‘nit-picking’, but he hoped for some ‘common sense’ in their approach to the new scheme.
Dr Vautrey told Pulse: ‘While practices must do their best to fulfil all the requirements of the DES to receive the payment in full, we would certainly hope and expect NHS England’s area teams to show some common sense and understanding in their approach to practices who are trying their best to take part in this new scheme.’
‘This was particularly the case with the patient participation DES where small and trivial omissions by practices meant they lost large amounts of resource.’
NHS England had been asked for comment but had not responded at time of publication.