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Older DES uptake plummets by a fifth as practices rationalise workload

Exclusive Many GP practices have ditched the older DESs rolled over from last year - including providing extended hours - after their workload increased under the contract changes from April, Pulse has learnt.

Data obtained from NHS England via a Freedom of Information Act request suggests that take-up of the patient participation, alcohol and extended hours DESs rolled over from last year has fallen by one-fifth year on year.

Pulse obtained comparable data covering around 2,195 GP practices across England. Between them, they have signed up to undertake 5,474 DESs during this financial year, compared with 6,837 in 2012/14 - representing a 20% decline.

The patient participation DES saw the biggest drop in take-up, attracting 83% of practices in 2012/13, but just 58% this year.

Meanwhile, the DES to provide health checks for patients with learning disabilities saw sign-up reduce from 78% to 63%, while the alcohol DES saw 67% of the practices signing up this year, compared with 78% last year.

And at a time when the NHS is looking at ways to increase access to general practice, the extended hours DES fell in popularity from 73% to 61%.

These data follow a Department of Health-commissioned study of GP workload that found GPs were the most stressed for 15 years, with over half of those aged over 50 years saying they intend to quit direct patient care within five years.

The survey also uncovered that the provision of extended hours is in a state of decline, with 16% of practices saying they do not offer any extended hours at all, compared with just 10% in 2010. Meanwhile, the number of practices that said they provided extended hours on weekends fell from 40% to 32%.

It comes after the Government rolled out four new DESs from 1 April this year, while also extending the amount of QOF workload for GPs in England. Pulse revealed in July that many had refused to sign up to the new DESs offered from April, with preliminary figures showing take-up rates were dipping to 55%.

Family Doctor Association chair Dr Peter Swinyard said the rise in GP workload was the likely cause of the decline in take up for older DESs.

He said: ‘This is probably an indicator of the incredible pressure that general practice is under at present.

‘We are really just struggling to do our main job, which is to care for people who are ill, and some of the enhanced services are just going by the board. Our practice managers are having to look carefully at all enhanced services to see whether or not it is actually going to be worth our while doing them.

‘They are having to take a very monetised view on all this and decide whether it pays to do it, or whether in fact it is a lot of effort for very little reward. And if that is the case then there is very little we can do except to say that we have to focus our efforts on direct care.’

Commenting specifically on the falling number of practices opting to provide extended hours, Dr Swinyard added: ‘A lot of practices were employing salaried doctors to do the extended hours. Now that partnership incomes are dropping so hard, we have to look at whether it is actually of value to employ salaried doctors to do the extra work. If you are paid £100 to do it and it costs you £120 you are not going to do it.’