Ministers have controversially pulled funding from tools designed to help GPs and NHS managers prevent patients with long-term conditions from being admitted to hospital – forcing commissioners to buy in tools supplied by private providers.
The Department of Health expects GPs and PCT commissioners to use risk prediction tools as part of a new model of care, which will see them stratify patients according to their risk of an unplanned hospital admission and identify and commission interventions to keep patients with long-term conditions out of hospital.
The technique underpins the long-term conditions workstream, part of the DH’s QIPP agenda. GPs have been set a target to cut unplanned admissions in patients with long-term conditions by a fifth by 2013.
But in a letter to PCTs earlier this month, Stephen Johnson, DH deputy director and head of long-term conditions, announced the DH would no longer fund the use of two risk prediction tools in the NHS – the Patients at Risk of Re-hospitalisation (PARR) tool and the Combined Predictive Model (CPM) – and would not commission newer versions as they are based on old NHS datasets that ‘are in need of an urgent refresh’.
The letter stated: ‘The current iteration is now outdated as the data on which the weights within the model were based are six years old. This is likely to adversely affect the accuracy of prediction… which means that the model is not compatible with current NHS data.’
‘The continued uptake and usage of risk stratification tools are fundamental to the success of the LTC QIPP workstream and the delivery of good LTC management. It is vital that commissioners understand the needs of their population in order for cost effective interventions to be targeted and prioritised.’
‘Those parts of the NHS currently using [the tools] may want to put in place plans now to either upgrade the model themselves or move to an alternative model as the Department of Health does not intend to commission a national upgrade.’
The decision to pull funding from freely available NHS risk prediction tools means PCTs and clinical commissioning groups would have to commission their own tools and buy in NHS data sets, or seek an alternative from the private sector, where providers including UnitedHealth and Dr Foster already offer tools.
The move has been heavily criticised by GPs, while health policy analysts, including the Nuffield Trust, which has researched the use of predictive risk modelling and its potential for use by GPs managing patients with long-term conditions, have also raised concerns.
Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Predictive risk models offer a valuable way of identifying people who are most likely to be admitted to hospital in future.’
‘It is now well recognised in the NHS that predictive risk tools are essential to use if high quality care is to be offered. In addition to commercial software solutions, it is important that there be a low cost or free option available to the NHS in future.’
‘There are advantages for the NHS Commissioning Board and others in the health service in being able to access such a standard model. We are exploring a range of models that might be needed in future.’
Dr Patrick White, a GP in Lambeth, south west London, who has researched admissions avoidance in patients with COPD, said: ‘I would be concerned about the idea that we can find other tools to prevent admissions from the private sector and I would be reluctant to support it.’
‘If it’s a model that going to be useful it has to be based in the community in which it is going to be used.’