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GP practices to risk breach notices if they don’t ask elderly about falls

GP practices could face breach-of-contract notices if they do not carry out checks on frail elderly from April, it has been warned.

But despite the NHS Employers guidance, the GPC has insisted that the 2017/18 contract deal includes ‘no new clinical work’ for GPs.

The new contractual requirement regarding frail elderly has replaced previous obligations under the scrapped avoiding unplanned admissions DES.

This means GPs will have to do clinical reviews of patients placed on an over-65 risk register, which they are asked to create using an ‘appropriate’ identification tool.

NHS Employers told Pulse that more detailed guidance would be issued closer to the contract start date.

But speaking to Pulse, GPC chair Dr Chaand Nagpaul said that ‘there is no new clinical work for GPs’ but rather ‘a reduction in the biggest area of frustration for GPs’.

According to Dr Nagpaul, the agreement removes ‘the whole bureaucracy’ of the DES, adding: ‘All you now have to do is a medication review and to ask frail patients about falls. These are the patients that are the most vulnerable in society and all of these patients will have been seen by a GP.

‘The requirement is not asking for a care plan, it is not specifying the detail of what you do. You are able to be a GP providing clinical care. Most of these people are on multiple medications and medication review is part of our normal practise. So there is nothing actually extra to do.

He argued that this was ‘just allowing GPs to be GPs, looking after their older patients’.

But NHS Employers warned in contract guidance that not carrying out the reviews could lead to breach-of-contract notices.

It said: ‘Recording such activity and reviews in the patient record is standard practice and as such, we do not anticipate that practices would not meet this contract requirement. Where this may not be the case, there is a standard operating procedure for dealing with breaches of contract.’

Dr Nagpaul also defended the GPC’s decision to agree to contractual automatic extraction of data on retired QOF indicators and enhanced services, a full list of which has now been published by NHS Employers.

He said: ‘This is something that has been done since 2004, when the [new GMS] contract was negotiated. The extractions have been going on now for years, and the majority of practices enable the extractions.

‘We’ve never had any issues around it and we will only be agreeing to clinically appropriate extractions. So we are not introducing something that practices are not doing.

‘The Government wants public health data, that is what their interest is, but it is not a new phenomenon and it is already being done by a majority of practices.’

But not all LMC leaders agreed with Dr Nagpaul’s reading of the terms of the contract deal.

Dr Dean Eggitt, medical secretary of Doncaster LMC and the only GPC member who abstained from an ‘overwhelmingly’ positive vote passing the contract deal, said he feared that there was ‘a sting in the tail’.

He said: ‘For years NHS Employers and the Government have been saying that there is no money in the pot to do XY and Z and then suddenly they find money to do all of these things. It’s incongruous, it doesn’t make sense.

‘Not that I am going to look a gift horse in the mouth and say no, but what are the strings attached to this? Like always, I think the saying is the devil is in the detail. I’ll be very keen to find out what we are tying ourselves into by accepting these positive contract changes.

He added: ‘I hope my colleagues are right and it’s all positive, but as always I remain sceptical.’

And Dr Grant Ingrams, the deputy chair of the GPC’s IT subcommittee, said: ‘I think Chaand is being shortsighted if he does not believe that the additional data will not be used for performance management. [I] expect it to be encompassed into CQC’s reports soon.

‘I am particularly sure that this will include the retired QOF indicators, with commenters not recognising (or caring) that the data will obviously be worse since retirement as practices will not be polishing the coding.’

What GPs will be contracted to do instead of the avoiding unplanned admissions DES

Wth the unplanned admissions DES withdrawn, £156.7m goes back into global sum. Instead there will be a contractual duty to focus on the management of patients with severe frailty, and:

  • Use ‘appropriate tool’ to identify over-65s who are severely frail, and deliver a clinical review, including annual medication review and also falls risk assessment, other interventions as clinically appropriate 
  • Where these patients do not yet have an enriched SCR, seek their consent to activate  
  • However, there will no additional reports or claims to make for payment, unlike under the current DES.

NHS England will collect data through automated extractions – however GPC said this would not be performance managed.


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