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GPs to do reviews of severely frail in place of scrapped unplanned admissions DES



The new GP contract will see GPs create a risk register of their severely frail, older patients and ensure these patients have regular reviews, in place of previous obligations under the ‘avoiding unplanned admissions’ DES.

Although it does not provide monies attached to the work the GPC said this will involve less work for GPs than the previous, bureaucratic DES – and will not be paid by performance.

Announcing the new GP contract, the GPC said that withdrawal of the unpopular DES will see £157m ploughed back into the global sum.

Instead, it says GPs will be required to identify their over-65s who are severely frail and deliver annual reviews to include medication reviews and falls risk assessments.

Practices will also be obliged to encourage these patients to give their consent for enriched Summary Care Records (SCRs).

However, the GPC stressed that GPs will not be required to produce any additional reports or make claims for the work done – unlike with the current DES.

The GPC said this agreement ‘ensures that practices are empowered to apply their own clinical judgement in the management of severely frail patients, as part of good clinical care, thereby ending the significant associated bureaucratic burden on practices under the current enhanced service’.

It added that the ‘percentage of patients with severe frailty is estimated to be significantly smaller cohort than that of the enhanced service’.

NHS England will collect GP practice data on this work – the number of patients recorded with moderate and severe frailty and the number of severely frail patients recorded with a fall in the past 12 months, and giving explicit consent to activate their enriched SCR – through automated extraction.

The GPC also stressed none of this would be used for performance management purposes.

What GPs are contracted to do instead of the avoiding unplanned admissions DES

Wth the unplanned admissions DES withdrawn, £156.7m goes back into global sum. Instead there will be a contractual duty to focus on the management of patients with severe frailty, and:

  • Use ‘appropriate tool’ to identify over-65s who are severely frail, and deliver a clinical review, including annual medication review and also falls risk assessment, other interventions as clinically appropriate 
  • Where these patients do not yet have an enriched SCR, seek their consent to activate  
  • However, there will no additional reports or claims to make for payment, unlike under the current DES.

NHS England will collect data through automated extractions – however GPC said this will NOT be performance managed