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One in 10 GP practices decline £20,000 unplanned admissions DES

Exclusive One in 10 GP practices in the north, Midlands and east of England has turned down the unplanned admissions DES, despite it being worth £20,400 to the average practice, Pulse can reveal.

The figures, obtained by Pulse, represent more than half of England’s GP practices and reveal that 4,031 out of 4,531 – 89% – signed up by the 30 June deadline.

LMC leaders said that many practices did not feel the workload was worth the significant chunk of money.

The new DES was funded via the retirement of 40% of the QOF and was part of a package intended to reduce bureaucracy compared with the arduous 2013/14 contract. However, many GPs disagreed with the analysis, arguing the DES workload was too heavy.

Under the terms of the DES, GPs are expected to identify the 2% most vulnerable patients on their list to set out individualised care plans, provide telephone access to advise on hospital transfers or admissions and reviewing unplanned admissions and readmissions.

Area teams in London and the south of England were still calculating take up, while Arden, Herefordshire and Worcestershire – where only 87 out of 234 GP practices are signed up to date – was excluded from the figures above because it has extended the deadline for signing up to 18 July.

But despite almost 90% of practices intending to do the DES, LMC leaders remained sceptical that it would bring added value to practices or patients.

Dr Bob Morley, medical secretary of Birmingham LMC said: ‘Like everything unfortunately practices tend to sign up to any bit of additional income that they can get and quite often tend to look at the top line rather than the bottom line, you know, of how much work is it going to cost them and what is the profitability of signing up.’

A Pulse snapshot survey of over 400 GPs earlier this year indicated that one in seven GPs would refuse to take on the DES, however several LMC leaders in the south of England have now said almost all practices have initially signed up to do it because of its significant financial value.

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, said: ‘Some practices are saying that the money isn’t worth it, that it is not enough money to cover the workload but virtually all have signed up to it, at least initially. Whether that will continue once they realise how hard work it is, we will see. It seems to be very bureaucratic.’

Meanwhile, Gloucestershire LMC chair Dr Phil Fielding said all local practices had signed up despite uncertainty of whether the DES would be successful.

He said: ‘In our punch-drunk state we have all signed up to it but the detail is very difficult to decipher, how it will be delivered. Only that we will find a way of incorporating any funding we can get to try and help bolster the service we provide. If you’re asking me if we have a grand plan, I don’t think we have. I think we have hopes and aspirations which the CCG wants to develop.’

‘But I don’t think anyone has the solution because the demographics tell us a story, that as our population ages and we get more complicated healthcare issues we are going to spend more, and anyone who says we can spend less and do the same I’m afraid probably isn’t a clinician.’

GPC deputy chair Dr Richard Vautrey said the figures were ‘in line with what we would expect’.

He added: ‘While there is a lot of work to do to fulfil the requirements of this new enhanced services there is also a significant resource linked to it and at a time of big cutbacks this is money that is essential for running the practice. In addition we hope that CCGs are supporting practices through the investment of the £5 per patient they are expected to use for this agenda.’


Name of area team

Take-up of Avoiding Unplanned Admissions DES

Total number of practices

North Yorkshire 230 233
South Yorkshire 194 215
West Yorkshire 310 328
Cheshire, Warrington & Wirral 159 170
Merseyside 193 238
Greater Manchester 484 499
Lancashire 225 231
Cumbria, Northumbria, Tyne & Wear 260 304
Durham, Darlington & Tees 154 172
Birmingham, Solihull and the Black Country 381 476
Shropshire and Staffordshire 208 243
Derybshire and Nottinghamshire 263 273
Leicestershire and Lincolnshire 226 248
East Anglia 242 292
Essex 262 274
Hertfordshire and the South Midlands 240 317


4,031 4,513
Excluded because of extended deadline:    
Arden, Herefordshire and Worcestershire 87 234

Source: NHS England

NOTE: Greater Manchester numbers were amended at 14.55 4 July after correction issued by NHS England.


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