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Is it worth signing up for the unplanned admissions DES?

Q What are the advantages of this year’s unplanned admissions DES?

Changes in the updated DES not only reduce the administrative burden GPs faced under last year’s version, but also make the work involved more profitable. While the maximum available funding of £2.87 per registered patient remains the same as in 2014/15, the apportionment of funding and number of components to complete have changed, meaning it should be easier to get the maximum funding. The potential annual income to be made equates to about £20,000 for an ‘average’ 7,000-patient practice.

Don’t fall into the trap of ignoring the associated costs though. Similarly to last year, practices must provide same-day telephone consultations for vulnerable patients with urgent queries, with follow-up arrangements as required. They must also provide timely access to relevant expertise, via an ex-directory or bypass number, to support decisions relating to hospital admissions and transfers. This could entail extra costs.

Q How does this year’s DES differ from last year’s?

The reporting requirements have been slightly reduced, with the reporting template now less than half the size of the 2014/15 version. Reporting is now predominantly through self-declaration, rather than the practice needing to pull together lots of evidence.

Care plans for patients who die or move away will now count within the 2% of the practice population that makes up the case-management register of patients at risk of unplanned admission.

Payments are broken down into three instalments this year, down from five. There is an upfront payment of 46%, followed by mid-year and end-of-year payments of 27%, both made subject to the achievement of certain requirements.

The process for making commissioning recommendations to the CCG is now much clearer, and data now only need to be submitted twice a year (in September and March), rather than quarterly.

Q What do I need to do before signing up?

Block out at least six hours of staff time to apply for the DES. If you’re a large practice and haven’t already compiled your at-risk register you might want to extend this to about 18 hours. Don’t forget to make sure your practice manager is available to fill out the application form.

You should also weigh up the potential income against the associated costs of running the DES. For instance, check that you will make back any money spent on extra clinical time or updating your telephone system – actions that might be necessary for signing up to the service.

Q How can my practice scope out the requirements of the DES?

Get in touch with the named lead for the overall ‘proactive care programme’ at your CCG to discuss the DES in more detail. They should be able to offer advice and guidance regarding risk stratification, and help you to reach the 2% target for your register.

Q Is there still going to be a survey attached to the updated DES?

In March, it was announced that NHS England might drop plans to survey the 2% of vulnerable patients GPs have signed up for the unplanned admissions DES. GPC deputy chair Dr Richard Vautrey says the planned survey has yet to be developed any further.

If it does go ahead, NHS England has confirmed there will be £500,000 of funding available to practices to run it.

Phil Harnby is manager at RMT Healthcare, a member of the Association of Independent Specialist Medical Accountants.