Osteoporosis DES offers 'no incentive to boost care'

Clinical DESs will do little to enhance patient care, experts warn.

The clinical directed enhanced service (DES) for osteoporosis will not incentivise practices to improve care of the disease, experts have warned.

Final details of the five clinical DESs for England were announced last week after months of discussions between NHS Employers and the GPC.

The DESs agreed will tackle osteoporosis, heart failure, alcohol misuse, learning disabilities and improve the recording of ethnicity.

A total of £5 million a year over two years has been allocated for the osteoporosis DES, meaning it is worth just £588.21 to the average practice.

To earn this, practices record women aged 65-74 and aged 75 and over who have suffered a fragility fracture in the previous 12 months, have had osteoporosis confirmed by a DEXA scan and are receiving treatment with a bone-sparing agent.

But Dr Alun Cooper, chairman of the National Osteoporosis Society's primary care forum, said: 'The DES will not make a difference to care as the funding is not enough.

'It needs to be on a par with the quality framework payments to make a difference.

'Practices that have been providing good osteoporosis care will use the money to continue doing so, but practices that have done nothing will continue to do nothing.'

Oxford GP Dr Sally Hope, who has an interest in osteoporosis, said: 'It is very disappointing - the DES funding will barely cover the administration costs.'

Values of other DESs were also confirmed this week (see box). Berkshire GP Dr George Kassianos, a member of the Primary Care Cardiovascular Society, warned that the heart failure DES, which requires initiating a beta-blocker and titrating the dose, may be too complex for some practices because of the level of training required.


Value of clinical DESs

  • Osteoporosis: £588.21 for an average practice.
  • Heart failure: £35 per patient.
  • Alcohol misuse: £2.33 per newly registered patient.
  • Learning disabilities: £100 for every health check.
  • Ethnicity: 5.6p per registered patient.

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