Controversial DESs given go-ahead despite GPC concerns

Plans for new directed enhanced services (DESs) funded by money stripped from the QOF will go ahead in 2013/14 despite intense opposition from GP leaders, the DH has confirmed.

New DESs will pay GPs to 'screen' elderly people for dementia, using money from QOF (Photo: iStock)
New DESs will pay GPs to 'screen' elderly people for dementia, using money from QOF (Photo: iStock)

The DH has announced it will scrap the organisational domain in the QOF and use the £164m to fund four new DESs, as first revealed in December.

The new DESs will cover case-finding of dementia, risk profiling and management of at-risk patients, remote care monitoring and improvements in online patient access.

The announcement comes despite fierce resistance to the plans from the GPC in its response to a consultation on the plans.

Announcing the final GP contract settlement for 2013/14, the DH said the new DESs would mean 'GP practices will need to provide better services for patients in these four areas to maintain the practice income that they have up until now received for demonstrating organisational best practice (e.g. good record-keeping)'.

The DH said the NHS Commissioning Board has been developing specifications for the new DESs and will publish these soon.

A letter from Richard Armstrong, DH head of primary medical care, has now revealed an outline of the services. The DESs will pay practices for:

  • the identification and case management of patients identified as seriously ill or at risk of emergency hospital admission
  • undertaking a proactive approach to the timely assessment of patients who may be at risk of dementia (based on opportunistic offer of assessment for dementia to at-risk patients who are aged 60 and over with CVD, stroke, peripheral vascular disease or diabetes; patients aged 40 and over with Down’s syndrome and other patients aged 50 and over with learning disabilities; and patients with long term neurological conditions which have a known neurodegenerative element, for example, Parkinson’s disease
  • enabling patients to use electronic communications for booking of appointments and repeat prescriptions
  • undertaking preparatory work in 2013/14 to support the subsequent introduction of remote care monitoring arrangements for patients with long term but relatively stable conditions (in 2014/15).

Responding to the announcement, Dr John Hughes, honorary secretary at Manchester LMC, said: ‘I think with the new DESs, the uptake will not be good. GPs will look at the amount of work involved and may well decide that it is not worth it and not in the interest of patients.’

In February, the GPC said it had a 'fundamental objection' to the new DESs in its response to the consultation on the GP contract.

GP leaders warned that forcing GPs to earn back QOF funding through new DESs risked practices losing thousands of pounds in income. Many will opt out of providing the services altogether as they would not be financially worthwhile, they said.

They also warned the dementia case-finding DES was not evidence-based and 'directly contradicts policy from the National Screening Committee and NICE'.

The GPC attacked the plans for greater use of telehealth as politically motivated 'interference' in the GP contract.

A GPC survey of 8,000 GPs across England found 79% believed the 'significant' extra work from the four DESs would have a 'major negative impact on their patient services, staffing and income'.

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