Share data to ease vulnerable patient care plan workload, GPs told

GP practices can ease workload fears over care plans for vulnerable patients by working with other health providers, an LMC has suggested.

Dr Nigel Watson: sharing information with other providers can help ease workload
Dr Nigel Watson: sharing information with other providers can help ease workload

Under the 2014/15 GP contract, practices will be expected to identify a minimum of 2% of their most vulnerable patients who are at risk of hospital admission.

GPs must then draw up detailed care plans for each patient they have identified.

Precise details of what will be required have yet to be made public. But some GPs have suggested that if the requirements are demanding, care plans could add more work than has been removed through this year's reduction in QOF targets.

However, Wessex LMCs chief executive Dr Nigel Watson said practices should take advantage of the fact that other local organisations already do much of the work required.

He said the amount of funding involved meant practices could not afford to opt out. 'If you look at it, that DES is worth £3 a patient. My practice would lose £45,000 if we didn't do it. We'll have to do care plans for about 270 patients.'

But he added that end-of-life care teams, nurses, hospices and oncology departments already draw up plans for many of these patients.

'A lot of the planning is done already, just not in a very formalised way,' said Dr Watson.

'Care homes have a care plan - a lot of that is done by nurses in the home, with input from us. You could improve care for patients and reduce the burden on practices, although I'm not saying it won't be extra work.'

Dr Watson said his practice was involved in piloting joint working with care home and hospice nurses.

'At least 10% of our work is duplicated because we are not well integrated with other services,' he said. 'We have a virtual ward twice a month and we discuss patients at that. We can convert the work we do into the plans, rather than starting afresh.'

He suggested practices may be able to draw on funding available through the £3.8bn Better Care Fund, intended to promote integration between health and social care.

Dr Watson added that it was up to CCGs to work with practices to make sure care plans were not drawn up by GPs in isolation, but as part of a wider effort to improve patient care across the health and social care system.

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