Exclusive: GPs in some parts of England have been granted an extension to sign up to the four new DES schemes - in some cases until September - in a move GP leaders have claimed demonstrates the folly of the Government’s contract imposition.
The four DESs, which focus on dementia, telehealth, online access and risk profiling and formed part of the 2013/14 GP contract deal, had initially set GPs a deadline of 30 June, meaning that all practices wanting to take on any of the services should have been signed up by now.
But deadlines for GPs in the north have been pushed back by the regions’ local area teams, while NHS England nationally said it expected local area teams to take a ‘pragmatic approach’ to the deadlines.
However, there appears to be some confusion over the implementation of the DES deadline, with NHS England unable to confirm which areas have granted an extension, the length of extension in each area or exactly which DESs had been delayed. It follows claims from LMCs last week that ‘chaos’ at NHS England has resulted in practices receiving late, incomplete and unidentifiable payments.
NHS England commissions all of the four DESs but outsources some aspects to CCGs, particularly for the risk-profiling DES. Pulse has learnt some CCGs, including Lewisham CCG in southeast London and North West Surrey CCG, have already completed the sign-up process while some others have delayed deadlines until a variety of dates spread across July and August.
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A spokesperson for NHS England’s North region, covering a number of local area teams, told Pulse: ‘The deadline for GP practices to sign up to the new DESs for 2013/14 was 30 June 2013; while we have encouraged our practices to adhere to this deadline, we are still receiving intentions to register from practices. In light of this, we are taking a pragmatic approach to ensure the delivery ofthe schemes by GP practices is not compromised so patients can benefit from the new services and payments for schemes provide value for money.’
Pulse also understands that deadlines have been extended in some parts of the Midlands and East regions, and that some of the extensions are until September. But the South region was unable to confirm whether deadlines had been extended and NHS England’s central office said it was not aware of any ‘significant’ extensions.
A spokesperson for the central office said: ‘We are not aware of any significant delays or issues that would, in turn, lead to delays in offering GP practices the opportunity to participate in the new enhanced services. However, should any area teams be experiencing delays we would expect them to take a pragmatic approach.’
Dr Russell Brown, chair of East Sussex LMC and a GP in Eastbourne, said he believed most of the DES sign-up was complete in his area but that he was aware of delays elsewhere in the south.
He said: ‘I think the deadline was met by most CCGs and area teams around here except for a couple of weeks’ extenson in some areas.’
The GPC said it was aware of delays and warned that they should not be allowed to affect payments to practices.
GPC deputy chair Dr Richard Vautrey said: ‘This was the inevitable consequence of imposing contractual changes so late in the day and at the same time as such a massive and chaotic reorganisation of the NHS. Practices do need more time and more clarity about DES requirements.’
Dr Chaand Nagpaul, GPC negotiator, added: ‘It doesn’t surprise me that this has happened. The contract imposition and the DESs were detailed at the last minute. Practices and commissioners received this important financial information at an extremely late stage and at a time when we saw the huge reorganisation of the NHS and when CCGs had to find their feet. Also GPs are overworked and for many practices the DESs have been a very low priority in the context of mounting workload.’
‘None of this is good, but I think it makes sense for individual area teams to delay the DESs because it has been particularly difficult to have this all announced so last minute. It is absolutely right that deadlines be relaxed allowing GPs the opportunity to sign up if they want, but remembering that many practices will choose not to take up the DESs because they need to take the judgement of whether they are actually cost effective. I would hope that payments should not be affected by a delay that was approved by the area team.’
