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Unplanned admissions DES could cause harm to dying patients, experts warn

Exclusive The new DES for avoiding unplanned hospital admissions could be harmful to patients who are dying unless managers relax stringent deadlines for practices, experts have warned.

National leaders on palliative care have requested that NHS England is flexible on tight deadlines within the unplanned admissions DES as they fear the 1% of the population in their last year of life may otherwise suffer undue distress.

It comes after Pulse revealed that NHS England has advised area teams not to pay practices for the DES if they miss any single aspect, despite previous reassurances from local area teams that they will be given leeway if it benefits patients.

Under the terms of the DES, patients requiring end-of-life care would be part of the 2% of each practice’s patient population that would have to be identified and informed that they were on the practice’s unplanned admissions DES register.

Each patient on the register will have a ‘named GP’, responsible for providing them with a personalised care plan and overseeing their care, with the aim of preventing emergencies that would see the patients admitted to hospital.

But Professor Keri Thomas, a former GP and now national clinical lead for end of life care at the GSF Centre CIC and honorary professor for end of life care at the University of Birmingham, said there was a danger of GP practices rushing to hit all the targets of the bureaucratic DES and ‘missing the point’ in the process.

She said: ‘Some of us are concerned about the way the very rapidly implemented unplanned admissions DES might possibly be negatively affecting patient care, especially for those nearing the end of life. There is a danger of hitting the target but missing the point.’

‘Although we greatly support the drive to reduce unplanned admissions and the need for more proactive primary care and advance care planning discussions, especially for the 1% of the population in the last year of life, we are concerned that the urgent box ticking required, with tight deadlines, might lead to some insensitive discussions and other measures that might cause distress if poorly handled.’

Dr Peter Nightingale, the joint Marie Curie and RCGP national clinical lead for end of life care, has produced a guide for GPs in which he has shared NHS Lancashire North CCG’s model for how to effectively care for dying people while carrying out the duties involved in the DES.

Dr Nightingale said: ‘We are asking for derogation from the local area team of NHS England to hopefully give the GP practices time to produce high quality and useful plans rather than a large quantity of lower quality plans. I understand that local area teams have been instructed to stick to the detail of the agreed DES, but asking for some flexibility in the interpretation of rules may still be worthwhile.’

Other tips include setting up a single IT template including all the codes for the DES as well as codes for a a local Electronic Palliative Care Co-ordination System.

In addition to sharing the guide, Professor Thomas and Dr Nightingale will be running two two-day workshops, endorsed and supported by the GMC, on how to best implement the DES for people nearing the end of life in September in Leeds and in London in October.



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