Directed enhanced services? Ditched enhanced services, more like. Because the new contract shake-up sees three of the new versions already consigned to the DES dustbin. Specifically, Risk Profiling will be swallowed up by the new Unplanned Admissions DES, Online Services will become a contractual requirement (see what they did there?) and Remote Monitoring has bitten the dust completely because no one gives a monkeys.
Except, that is, me. If it’s possible to mourn for a DES, then it’s Remote Monitoring that I shall shed a tear over. Not for the Tomorrow’s-Worldy ‘smart-toilet which each day performs a urinalysis on your morning micturition and electronically communicates it to your GP as a pee-mail’ sort of remote monitoring, because we all know that doesn’t work (and I don’t mean the technology, I mean the entire concept). I’m referring to the decidedly lower-tech versions - such as remote blood pressure monitoring.
Consider, for a moment, what remote BP monitoring would achieve: a dramatic reduction in patients attending for routine BP checks. And, therefore, a corresponding reduction in ‘while I’m here’ complaints raised by punters fully aware that attending something as tedious as a BP check is only worthwhile if it provides a forum for symptoms too trivial to be brought to a ‘normal’ appointment.
Imagine that. Then imagine the same applying to asthma, COPD, CHD, hypothyroidism et al. Suddenly, GP life seems almost worth living.
True, the payment for the original DES was only something like a groat per patient. But it was a PREPARATORY DES, remember? It offered more to come. It offered us untold riches if we managed to keep the patients away. See what we’ve lost? See why we should weep?
I can’t help wondering if we’ll ever see an opportunity like that again. The odds seem, well, remote.
Dr Tony Copperfield is a GP in Essex. You can email him at firstname.lastname@example.org and follow him on Twitter @DocCopperfield.