ࡱ> fhe[@ .bjbj44 .bViVi&oFFFFFFFZ8TJtZ/"///////$1Rm3.6/Frrr6/FFK/***rFF/*r/**<+|FFH- *t=BL,-,a/0/^,4 4$H-ZZFFFF4FH-hTJ*<6/6/ZZdXZZ There are four new Directed Enhanced Services (DESs) in this document which comes into effect on April 1st in England only. Under devolution, the other parts of the UK will have their own arrangements. These are Access to GP services, (Access) Choice (sic) & Booking, (C&B) Towards Practice Based Commissioning (PBC) Information management and technology (IT) Access and Choice will be partly paid based on the response to a National Patient Experience Survey (the Survey) (q.v. page 4) that will be conducted centrally. Importantly the practice administered QOF survey on access will also continue for another year (v.i.) The C&B and PBC DESs are for one year only but the Access DES specification will be reviewed in a years time. The Access DES will focus on four dimensions (sic) The opportunity to consult a GP within 2 working days The opportunity to book more than 48 hours in advance the ease of telephone access the opportunity to see a practitioner of choice It will be funded by taking the value of 50 QOF points and the value of the 2005/6 access DES which will add up to 108 million or 2.07 per registered patient. If practices choose to participate they can earn money which will be paid in two components. The first component will be worth 1/3 of the total i.e. 69p per registered patient (p/pt) but will be paid in two halves. The first on agreement of a written plan and the second for the practice continuing to take part in the monthly Primary Care Access Survey (which will be revised by being made more random in its timing and asking for the third available appointment). The second component the final 2/3 or 138 p/pt will be paid pro rata according to the results of the Survey conducted in the final quarter of 2006/7. Because of the time this will take practices are advised that money will be received in the first quarter of the next financial year. Target Area Weighting pptMin. satisfaction level% payable at min satisfactionSatisfaction level for 100% payment48 hr30%4150%5090Advance30%4140%4090Telephone30%4130%5080Dr choice 10% 14 20% 40 80 The Choice & Booking DES can, in fact, be considered as two quite separate and independent DESs. Choice: Practices are expected to provide support for patients to make an informed choice about the provider of secondary care and to use Choose & Book. The patientss referrer normally their GP should generate a shortlist of appropriate choices, and should initiate a choice offer and discussion using information including waiting time information provided by the PCT. Fifty percent of the 48 p/pt available for this component will be payable as an aspiration payment on agreement of a written plan with the PCT. The rest will be paid on the results of the Survey if at least 60% of the patients surveyed remember being offered a choice of provider. Choose & Book: An aspiration payment of 24 p/pt will be made to practices who undertake to use C&B for at least 25% of first referrals in June 2006. The second component of 24 p/pt will be paid according to a sliding scale based on the percentage of the total number of referrals made via the C&B system between September 2006 and the end of February next year. 50% of referrals will yield 60%, 90% will pay 100%. All referrals, including two week cancer referrals, are to be included it appears. Such confidence is expressed in C&B that absolutely any method of using C&B will be acceptable and, if the system falls down (sic), then pro rata payments will be made for the work done. The Towards Practice Based Commissioning DES will support engagement in PCB for one year only. The first component worth 95 p/pt will be paid on the agreement of a written plan with the PCT and will be based on list sizes as on 1st April 2006 but practices can sign up at any time this year. The payment is for the practice time needed to develop and implement the plan PCTs will be expected to support practices or groups of practices in supplying as a minimum Referral rates Admission rates First OPA attendances and follow-up rates Inpatient & day case elective surgery data Non elective admission rates and data on length of stay Diagnostic test and procedure use Consultant-to-consultant referral information A&E attendances Prescribing Community & Mental Health services usage One can only doubt the present capacity of NHS management to provide this information in any meaningful way. The authors of this document obviously think so too because if there is dispute, the PCT should work with the practice to ensure an accurate data set is agreed. Plans should take into account PCTs strategic and local priorites and practices must demonstrate plans that have a strong commitment to improve the quality of care for patients which means more within primary care and most appropriate use of secondary care which seems to mean less of it, especially unscheduled. The method by which success will be assessed will be one of the points set out in the initial plan. If success is demonstrated then a second component of 95 p/pt will be payable but will be expected to be invested in activity designed to ensure continued or improved achievement and will not be available in addition to resources freed from the PBC budget. If these do not add up to 95 p/pt then the difference should be made up by the PCT. The Supporting Information Management & Technology DES is designed to support the delivery of the National programme for IT. There are specified, nonrecurring payments for successful preparation for and introduction of new IT systems and processes. Because roll out will be staggered across the country so will be payments. The money is for paying for protected time for practice (not PCT) staff training. Component one will be worth 40 p/pt according to list size on April 1st and should be payable as soon as possible on agreement of the inevitable written plan with the PCT. This should include A nominated practice lead A nominated Caldicott Guardian A training needs assessment and training plan for each member of staff involved in operating IT. A log of training undertaken both inside and outside the practice should be kept including a signing off process. Evidence of compliance with good IT governance practice e.g. compliance with the Data Protection Act, confidentiality clauses in contracts of employment. All practices are expected to be connected to N3 by the end of the DES and every member of staff have a smart card and not be afraid to use it. The second component is for working towards data accreditation in readiness to upload electronic patient summaries onto the Spine. It is not expected that actual uploading will occur in 2006/7 except in pilots and there will not be expected to be discussion with patients about their data under this DES. A demonstration of workable and regularly updated summaries is required including repeat prescriptions linked to coded problems and allergies and adverse reactions are recorded. These standards are already those to which the medical profession has agreed. Practices will be expected to be part of the PRMIS+ network which will help with the necessary audits. Following accreditation 44 p/pt will be payable. Component three is worth 27 p/pt will be paid for maintenance of accurate records of patient addresses and preparation for the Electronic Prescription Service using EPS Release 1 software. Component four, 22 p/pt, will be paid following migration to a CfH accredited hosted system. Pro rata payments will be made for the work done should national or regional problems prevent full implementation of any component of this DES. The National Patient Experience Survey will be conducted as part of the validation process for the Access and Choice & Booking DESs. Details are sketchy but it is clear that neither practices nor PCTs will do the work but an independent polling organisation will be engaged. A statistically significant sample of patients for each practice will be economically surveyed in some unspecified way, but no doubt corrected for bias in contact method (will it be by phone, online or in person?) and for those patients who refuse to answer on the basis that they have not visited their doctor for years or because they consider what they and their doctor discuss to be private, or have recently been upset by receiving a serious diagnosis and therefore resent being asked even the simple, anonymised, anondyne questions given here. When you last contacted the (note not your) practice, were you able to consult a GP within two working days? When you last contacted the practice to make an appointment for a problem that was not urgent, could you book ahead? Are you satisfied with the ability to get through to your practice on the telephone? When you last contacted the practice with a problem that was not urgent, were you able to make an appointment with a particular GP if you were prepared to wait? Do you recall a conversation with your GP about choice when you were referred for your first consultant outpatient appointment? For the first time then part of the income of English GPs will depend on a few patients recollection of events and perhaps his or her prejudices towards the GP. It should be noted that this was flatly rejected in Wales where practices will be paid under a separate DES to collect the data themselves. English practices might consider duplicating this work because we understand that the independent survey will not be challengeable otherwise. This would appear to be a clumsy attempt to drive a wedge between patients and practices which will probably be costly, intrusive and inaccurate. More information about the Survey will be available later in the year.     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