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Beware of the GP contract you wished for



So here we are in the post-coital glow of a new contract that, for once, hasn’t screwed us, if that’s not a contradiction in terms. And yet, there’s that uncomfortable feeling, isn’t there? A feeling that says, somewhere amid a contract that feels so benign, there must be something neoplastic.

Especially in the vexed area of the Avoiding Unplanned Admissions (AUA) DES. This proved to be a bureaucratic, bean-counting, ball-aching nightmare which demonstrated only what we knew already, specifically that a) We can’t avoid unplanned admissions and b) Writing care plans involves  a lot of planning but very little caring. Having this replaced with what amounts to an Avoiding Unwanted DESs DES sounds too good to be true.

So maybe it is. A quick look through the explanatory blurb sets some alarm bells ringing. Instead of the AUA DES, we’ll be obliged contractually to ‘…focus on the management of patients with severe frailty’. On the one hand, we’re told we can apply our own clinical judgement while, on the other, we’ll have to use an ‘appropriate tool’ to identify these patients. We’re told, too, that it’s bureaucracy-free, yet we will have to code various onion-layers of category and intervention annually, such as level of frailty and fall-overability. And we’re told that data will be extracted automatically, not for performance management but, ‘To understand the nature of the interventions made’, a statement which is vague and meaningless and therefore worrying – particularly given that it’s hard to imagine what these data could be used for other than applying thumbscrews.

This last issue is the one that perhaps should have us evacuating the building. Data collection creep via CQRS is happening while we doze – and has been reinforced by the new contractual requirement to enable data collection of retired QOF and DES indicators rather than hum and hah over the invites as currently. Bland reassurances don’t wash, and with good reason: failure to evidence adequate numbers of returned Friends and Family Tests (FFT) via CQRS has prompted threats of mandatory training on FFT, FFS. Hilarious, but less so if this default monitoring is used to pick holes in weightier parts of contract or performance.

And data can be misappropriated, of course. Just ask any practice branded by local media as ‘One of the worst in Essex’ thanks to CQC ‘Intelligent Monitoring’ aka wanton abuse of QOF data. Like ours.

So thanks GPC. We got what we wished for. And therefore we should be careful. We are, after all, frail, and liable to fall over.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield