NHS England defends £162m DES as data suggest care plans do not cut admissions

NHS England has defended the £162m unplanned admissions DES after official data suggested that asking practices to write care plans for vulnerable patients does not reduce hospital visits.

Data published last month suggest that providing care plans and reviews for vulnerable patients registered for the reducing unplanned admissions DES does not affect admission rates.

GPonline analysis of data published by the Health and Social care Information Centre showed no correlation between the number of registered vulnerable patients given care plans and care plans reviews, and the number admitted to hospitals.

The GPC said that GPs had known all along that the bureaucratic work required by the scheme was unlikely to reduce admissions. But NHS England defended care plans and said comparing rates of plans and admissions between practices did not reflect the various factors that affect admission rates.

Unplanned hospital admissions

Analysis of the data also showed that hospital admissions of registered vulnerable patients increased over the final six months of 2014/15, the first year of the scheme.

The DES was funded with £162m in its first year, paying £2.87 per registered patient to practices, or £20,000 per average practice.

Practices are required to identify at least 2% of their patients as vulnerable and provide proactive care including care plan and reviews, to reduce the likelihood of admissions.

But analysis suggests there is no correlation between providing care plans, or care plan reviews, and the rate of admissions.

The data also revealed wide variations in the rate of admissions for registered vulnerable patients between CCG areas.

Variations between areas in the percentage of patients provided with the care plans required by the DES, and the in the numbers of patients who had not had their care plan reviewed, suggested practices in some areas may be struggling with the workload required by the service.

Postcode lottery

In some areas high rates of compliance with the care plans requirements still resulted in high hospital admission rates. But across the board, the analysis suggests there is no correlation between the care plan work and admission rates.

GPC deputy chairman Dr Richard Vautrey said: ‘GPs have known all along that it was unlikely that producing care plans for patients through this bureaucratic scheme would reduce the number of admissions to hospital. Admissions occur for many and often complex reasons and it would be far too simplistic to assume that this enhanced service, which focuses on far too many patients to be meaningful, would make any significant difference to this.

‘As part of this year's contract negotiations GPC secured agreement with NHS Employers to discuss ending this enhanced service next year and add the funding into core practice resources. This would enable them to deal with their most vulnerable and complex patients in a more professional and tailored way, without the added and unnecessary bureaucratic burden that this enhanced service brings.‘

An NHS England spokeswoman said: ‘A well co-ordinated care plan reduces the stress and anxiety of admissions, improves working between health and social care providers and helps patients and their carers understand their health needs. Care plans are targeted at vulnerable patients with long-term conditions and will help reduce unnecessary admissions, but as patients conditions progress individual admission rates may increase.

‘There can be a variety of factors involved in admissions and simply comparing rates between practices is not an accurate reflection of the benefits that such plans bring to patients.’

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