What’s it all about?
A new unplanned admissions Direct Enhanced Service (DES) has been introduced as part of yet another move to reduce unnecessary emergency admissions to secondary care. The new DES places emphasis on practice availability to patients at risk of hospital admission with the main work of the DES being the proactive case management of at-risk patients. This whole service could cost approximately £160 million of NHS money.
However, researchers have said the evidence shows case management as proposed in the DES is unlikely to reduce unscheduled admissions, without significant improvements in other areas of the NHS.
What are the key features?
Like previous risk profiling exercises, Practices will need to use a risk stratification tool to identify vulnerable older people, high risk patients, patients needing end of life care and patients who are at risk of unplanned admission to hospital. Practices will also have to provide these vulnerable patients who have urgent queries with same-day telephone consultations or with follow-up arrangements where necessary. It looks like this is going to involve a considerable amount of time and effort, especially since Practices will have to produce personalised care plans for patients on the case management register.
These care plans should identify a care co-coordinator who would be the most appropriate person within the multi-disciplinary team to be the main point of contact for the patient or their carer to discuss or amend their plan. The care co-ordinator will also be responsible for ensuring that the agreed care plan is being delivered, that the patient or carer is informed of any changes made to the plan and keeping in contact with the patient or their carer at agreed intervals. The care co-ordinator could be the usual GP, but it would be much more cost effective to have another healthcare provider take on this role.
What are the timescales for the new service?
Following pressure from the GPC, the revised guidance clarifies that care plans for patients initially added to the case management register have to be in place by the end of September 2014, not June 2014 as was originally specified.
Patients initially added to the case management register have to be informed of their named accountable GP and care co-ordinator by the end of July 2014. The July deadline for the named accountable GP applies only to patients added to the register who are under the age of 75, as patients aged 75 and over will have been informed of their named GP by the end of June (existing patients) or within 21 days of registration (new patients), as per the requirements of the GMS and PMS regulations.
Link
Revised guidance on the unplanned admissions enhanced service can now be found at http://www.nhsemployers.org/. The changes made are on pages 7 and 15 of the guidance. The Care Plan template is on page 31 of the guidance.
