A month in to the 2017/18 GMS contract changes in England and the avoiding unplanned admissions (AUA) directed enhanced service already feels like a distant memory, or perhaps a long-forgotten nightmare. Ending the scheme has made a tangible difference to practice workload. No longer do practices need to be worried about hitting a 2% target for producing and reviewing care plans, nor do they have to do monthly reviews of their register or hold unnecessary meetings simply to tick a bureaucratic box.
It’s now up to practices how they enable patients, carers and healthcare colleagues to contact the practice rather than being micromanaged on what telephone systems they have in place. Retaining the £156.7m spent on the AUA DES within the core contract means GPs and their teams can now get on with the care of vulnerable patients without so many unnecessary and unhelpful strings attached.
One of the great success stories of UK general practice has been the part we have played in enabling more and more people to live longer and often healthier lives.
However, we are also far more aware that increased longevity can also bring with it increased frailty. From July practices will be encouraged to focus on this group of people, using an appropriate tool, such as the Electronic Frailty Index (eFI) which is integrated in clinical IT systems, to identify patients over the age of 65 who are living with moderate and severe frailty.
It is important to note that these tools should be seen as guides only, and the decision to code someone as moderately or severely frail should be made by a clinician guided by - but not restricted by - the electronic score. It may not be clinically appropriate to add a code to the record of a patient that your computer system suggests is moderately frail, but it’s much more likely to be relevant for someone identified as severely frail.
These will also be the patients seen in the practice on a regular basis and who would benefit from a medication review, being mindful of the risks of polypharmacy and inappropriate treatment. Thoughtful use of exception reporting for QOF domains may also be worth considering as GPs use knowledge of their patients to tailor treatment based on the holistic needs of individuals rather than slavishly following disease specific guidelines.
Patients living with severe frailty are at higher risk of falls so it’s worth asking about this as part of routine consultations as well as considering whether to activate an enriched summary care record for those patients who are receiving support from a range of others who would benefit from access to more clinical information.
Unlike the now-defunct AUA DES, all of this activity should take place on an opportunistic basis over the course of the year and crucially there are no targets to hit or any need to create additional processes or offer extra appointments to do this. The intention of these changes is to both reduce unnecessary workload and also empower clinicians to make clinically appropriate decisions for the benefit of their patients, not for the sake of chasing an arbitrary target.
As GPs gather this week from across the UK for the annual LMC Conference, we’ll need to focus on what other steps can be taken to reduce workload and empower GPs, for we must do more to restore the professional pride of GPs and further reduce unnecessary box-ticking and pointless targets.