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NHS England sets out key elements of enhanced service for complex needs

Option becomes available in April; aim is to cut avoidable unplanned admissions

Caroline White

Tuesday, 18 February 2014

GPs will need to carry out regular risk profiling to identify at least 2% of adult patients with complex needs, if they are to provide an enhanced service to cut avoidable unplanned admissions among this group, the deputy director of NHS England, Mike Bewick, has said.

But they will become more accountable for coordinating the care of patients with more complex needs, if they sign up to the service, when they are offered the option to do so from 1 April, he says.

The enhanced service is designed to reduce avoidable unplanned admissions by improving services for the most vulnerable patients and those with complex physical or mental health needs. 

In a bid to define the core elements required, Mike Bewick advises that designated practices will need to ensure that other clinicians can easily contact the practice by telephone to support decisions relating to hospital transfers or admissions. 

And they will need to carry out regular risk profiling to find at least 2% of adult patients as well as any children with complex needs who stand to benefit from more proactive care management.

Practices will also need to proactively support patients at risk by developing and regularly reviewing personalised care plans, and by ensuring that these patients have a named accountable GP and care coordinator.

And they will need to work with hospitals to review and improve discharge processes and undertake internal reviews of unplanned admissions/readmissions.

“All of these elements, taken together, will lead to GPs being more clearly ‘accountable’ for coordinating the care of patients with more complex needs,” explains Mr Bewick.

He goes on to say that NHS England has been able to create this enhanced service as a result of lopping a third off the scope of QOF, which will allow “GP practices a greater opportunity to understand the needs of the patients who most need their support to stay well in the community and avoid unplanned hospital admissions.”

But the approach “needs to be a real partnership between CCGs and GP practices,” he advises, referring to the NHS planning guidance Everyone Counts. This sets out an expectation that every CCG should spend £5 per patient from its 2014-15 allocation to support practice plans for improving services for older people. 

This money is intended to fund additional services beyond those provided for by the new enhanced service, he says. These could be new services based in general practice, rapid response community nursing, designated district nursing, additional discharge coordinator services, or additional services from third and voluntary sector providers, he suggests. 

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