New GMS 2013/14 DESs 'may be unviable'

Struggling practices may need to refuse new DES work because it could be financially unviable, the GPC has warned.

GP leaders said the profession was being forced to take on new DESs to earn back thousands of pounds of income stripped from QOF under the contract settlement imposed by the government.

They said practices faced 'difficult choices' and urged them to 'look at the bottom line' when deciding if the extra work is worthwhile.

Meanwhile, doubts emerged over whether some new QOF indicators are worth pursuing, due to stringent funding and far tougher thresholds.

The GPC's warning came after NHS England - formerly the NHS Commissioning Board - set out funding details for four new DESs from April (see box). It also published full guidance for the 2013/14 QOF.

GPs will have until 30 June to sign up to the DESs, worth up to £15,500 to the average practice. The DESs are funded with £120m from retired QOF indicators.



Target Identify patients at risk of dementia, offer cognitive checks, refer to memory services, offer health checks for carers.

Payment 37p per patient as upfront payment (£2,587 for average practice), then a share of £21m national pot, averaging £3,367 dependent on number of checks carried out.

Risk profiling and care management

Target Scan lists each quarter for patients at risk of emergency admissions, develop case management plans to reduce risk.

Payment 74p per registered patient (£5,175 for average practice).

Remote care monitoring

Target Select a long-term condition and plan to introduce a remote monitoring service in April 2014.

Payment 21p per patient (£1,478 for average practice).

Improve patient online access

Target Introduce electronic booking of appointments and repeat ordering.

Payment 28p per patient (£1,970 for average practice), plus a flat rate of £985.

Total earnings £15,562

A dementia DES will see GPs offer cognitive checks to as many as 2.4 million at-risk patients, including those with cardiovascular disease, diabetes and neurological problems. The DES also encourages referral to memory services and health checks for carers.

In addition, practices will need to improve online appointment booking, carry out risk profiling to avoid hospital admissions and plan to introduce remote care monitoring from next April.

Current DESs for extended hours, patient participation, alcohol reduction and learning disabilities health checks will roll over into 2013/14.

GPC deputy chairman Dr Richard Vautrey said: 'We should be clear this is £15,500 that has been taken from practices and they are being invited to earn it back by doing extra work on top of the work they are already doing. This is not new money and the government hasn't taken any work away.'

He said practices struggling under heavy workloads will have to make 'difficult choices as to whether it is financially sensible' to take on the work to earn back this funding.

'Practices need to look at the bottom line, not the top, when making this decision, and factor in all the increased expenses they would incur in order to try to achieve these,' he said.

Wiltshire GP and QOF expert Dr Gavin Jamie warned the new DES specifications were so vague, it would be 'almost impossible' for practices to decide in advance if they are worthwhile (see GP expert view, below).

Dr Jamie said it was also 'marginal' whether a new diabetes dietary review indicator was worthwhile, because it will pay only £1.55 per check at the full level of achievement.

Likewise, a new target to give exercise advice to patients with hypertension will earn practices on average just £1.08 per eligible patient after costs.

The GPC has warned that tougher thresholds could cost practices £11,000 as they battle to raise performance at a time of ever-increasing workload.

Expert view - Which DESs will be worthwhile?

Wiltshire GP Dr Gavin Jamie

'The enhanced service specifications are perhaps most notable for their vagueness and being almost impossible to cost.

'Risk profiling is largely to be determined at CCG level, so there will be about the same amount of money nationally for variable amounts of work.

'The dementia guidance is clear that this is expected to be done opportunistically, but there is now even more to squeeze into 10 minutes.

'Remote care monitoring is even more bizarre, in that it will involve no remote care monitoring at all this year, just getting ready for next year. Online access is probably worth it, if you feel 5% of patients is feasible - it's great for practices with younger, affluent populations.

'Politically, NHS England has left a lot to CCGs. These are quite "hands off" specifications, but equally are likely to push CCGs into awkward positions. GPs on the boards will have to consider their interests quite carefully.'

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