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GPs to be allowed to drop unplanned admissions DES and retain funding under CCG plans

Exclusive GPs in one area of England will be given the chance to drop the unplanned admissions DES from April and instead receive payment for advance care planning and end-of-life care for 0.5% of their patient lists.

Speaking at the Pulse Live conference in London today, Dr Graham Jackson, chair of NHS Aylesbury Vale CCG, also revealed that it will offer GPs the chance to drop certain elements of the QOF as soon as the CCG takes on ‘joint commissioning’ responsibilities alongside the local area team in April.

Dr Jackson explained how the CCG wanted to develop detailed information about the quality of care planning, instead of spending lots of money on ‘achieving very little’.

This is the biggest change to the GP contract announced by a CCG taking on co-commissioning responsibilities, after Pulse revealed that at least 12 CCGs were considering dropping the QOF.

More than 70% of all CCGs have taken on some form of co-commssioning responsibilities, at either Level 2 – allowing ‘joint commissioning’ alongside NHS England local area teams – or Level 3, which gives them full delegated responsibility for commissioning primary care.

NHS Aylesbury Vale CCG has taken on Level 2 ‘joint commissioning’ powers alongside the local area team under co-commissioning, which NHS England hopes will improve sustainability and effectiveness of primary care.

The plans, approved by the NHS Aylesbury Vale CCG board last week, will enable GPs to drop NHS England’s flagship scheme, which requires GPs to develop care plans for their most vulnerable 2% of patients.

Instead they will be asked to conduct and review the advance care plans of 0.5 % of the practice population, half of the population at risk of dying within the year.

The GP will register the patient’s preferences on where they wish to die, and then conduct quarterly audits of the deceased population to investigate whether their place of death matched these wishes.

GPs will also be offered the chance to opt out of all diabetes-related QOF domains, and receive payment at their level of achievement last year and potentially 20% on top, in exchange for running CCG-funded staff training on long-term conditions care planning.

Dr Jackson added that the dementia and respiratory QOF domains could also be added to the scheme in future.

He told Pulse Live delegates: ‘We’re offering our practices suspension of the unplanned admissions DES as it stands. And then we’ll rewrite it to say that we’re interested in what’s happening with quality at end of life, we’re interested in where they die: do they die in the right place? Are their advance care plans properly structured?’

Speaking to Pulse afterwards, Dr Jackson added: ‘Essentially, we’re looking at quite a few deaths. We say that 1% of your population are predicted to die in a year. We’re saying let’s take half of that population, and what we want to know is are people dying in the right places.’

He added: ‘At the moment, we are spending big money on the unplanned admissions DES that really is achieving very little.’