Exclusive: Unplanned admissions DES forces practices to cut appointments

Two out of three GPs say their practice has been forced to sacrifice appointments to produce care plans required under the unplanned admissions enhanced service, a GP magazine poll reveals.

Consultation: DES forced practices to cut appointments (Photo: JH Lancy)
Consultation: DES forced practices to cut appointments (Photo: JH Lancy)

An even higher proportion say the directed enhanced service (DES) will not benefit patients’ long-term health, the survey found.

The DES is intended to keep at-risk patients out of hospital, but of 446 doctors who responded, 328 (74%) said it would be of no benefit to patients in the long term, and just 44 (10%) thought it would improve patients' health.

Of 432 GPs who were taking part in the enhanced service, 285 (64%) said planning its introduction had meant the loss of some patient appointments at their practice. Just 79 (18%) said they had managed to plan the service while maintaining a full schedule of appointments.

Bureaucracy criticised

Introduction of the DES will be worth around £20,000 to the average-sized practice, but since details were announced earlier this year, there have been criticisms of unnecessary bureaucracy.

Asked how the DES would affect their patients’ health, one GP said: ‘These patients already are accessing the service to meet their health needs. This does nothing to improve access or their care and certainly does not prevent admissions as the services required in the community to do this are hugely under-resourced.’

Another wrote: ‘The premise that there are admissions that we could avoid by writing a plan is unfounded, there is no evidence for it. I fear that elderly people will not get admitted when they need acute medical care because they have one of these plans at home.’

And another said: ‘I think care plans could work if done as part of wider package. However the ultimate goal shouldn't be reducing unplanned admissions it should be improving quality of life and quality of care.’

Impact on workload

Asked about their practice’s workload while planning for the DES, one GP said they had had to cut around 100 appointments, one doctor said all partners at their practice were working 12 hour days to produce the care plans, and another said the planning had taken the equivalent of one GP’s entire working week, for three weeks.

And one GP said: ‘I have personally spent 80-90 hours doing care plans instead of seeing patients!’.

BMA GPC deputy chairman Dr Richard Vautrey said: ‘It's not surprising that so many GPs have concerns with this DES as it has turned in to a bureaucratic monster. This is why we've insisted on, and achieved, changes for the coming year as part of the 2015/16 contract negotiations.

‘We still need a much more sensible and supportive performance management regime from NHS England and CCGs to fully utilise their £5 per patient on a recurrent basis to enable practices, working with community teams, to develop the additional capacity required to deliver care to the most vulnerable patients.’

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