GPs will have to go through their practice lists to identify and case manage patients who are at risk of unplanned hospital admissions, under the terms of a new DES released by the Department of Health today.
The DES aims to ensure that frail older patients and those with mental ill health are kept out of hospital, but will mean practices will have to carry out regular risk profiling of patients to identify those at significant risk of unplanned hospital admissions.
Under the draft terms of the DES published today, practices will have to agree to case manage a proportion of these patients with the NHS Commissioning Board in order to the number of unplanned hospital admissions.
A nominated lead professional will be responsible for each patient being case managed and they will have to carry out a review of each patient’s case management of their clinical and care needs ‘at a specified frequency’. Practices also need to hold regular multidisciplinary integrated care meetings for the case management of each patient.
The DES will be funded by the cash released from the abolition of the organisational domain of QOF.