DESs for 2008/2009

Directed Enhanced Services (DES) are special services or activities provided by GP practices that have been negotiated nationally. All practices can choose whether or not to provide these services.

The following DESs have been agreed for 2008/09:

• Five new clinical DESs:
  • Heart Failure DES - improving the treatment of heart failure and including incentives to provide beta-blockers to appropriate patients. Practices will get £35 per patient treated under this DES.
  • Alcohol DES - helping to reduce the risk of adults, aged 16 years or over, drinking at 'hazardous and harmful levels' defined by the World Health Organisation. Practices will get £2.33 for each new registered patient that has been screened.
  • Learning Disabilities DES - annual health checks for people on the local authority learning disability register. To participate in this DES, practices need to attend a multi professional education session run by their PCT. Practices will get £100 for every health check.
  • Osteoporosis DES - encouraging practices to diagnose and prescribe appropriate pharmacological secondary prevention for patients with osteoporosis. Payments will be based on three criteria covering diagnoses and treatment. The payment per average practice that meets all three criteria is £588.21
  • Ethnicity DES - rewarding practices for recording the ethnicity and first language of all the patients on their practice list. Practices will get 5.6p per registered patient
• Extended Opening Hours Access DES - practices are rewarded for providing around 3 hours extra appointment time per average practice a week, at times that suit the needs of their patients. Practices are paid £2.95 per registered patient. The Department of Health (DH) has issued more detailed guidance to PCTs

IM&T DES (rolled over from 2007/08) - practice eligibility to receive one-off payments will continue for England for 2008/09. The Department of Health (DH) has amended the Statement of Financial Entitlements (SFE) to allow PCTs to make payments until 31 March 2009

The DH is currently drafting the legal documentation for the five clinical DESs. In the interim, the detailed guidance aims to support PCT discussions with practices on providing these DESs. You can find more details on the inflationary uplift and Access DES on the DH website.
Access DES

The Department of Health has issued guidance to PCTs and strategic health authorities that clarifies the detail of the access DES. In particular:

• it explains how PCTs with existing local schemes should discuss these with the relevant practice(s)
• it highlights some key issues that PCTs should consider when commissioning extended hours such as the provision of linked services, safety and security and religious and cultural sensibilities
• the guidance provides a clear definition of the requirements of the DES, including detail about how the extended opening hours should be calculated and how the hours should be provided
• it describes how PCTs should monitor performance and delivery of the DES and instructs PCTs how to monitor the progress of the DES using Unify2
• it explains the payment arrangements for the DES.

http://www.nhsemployers.org/pay-conditions/primary-893.cfm

Information from NHS Employers website.

Integrated Care Organisations

ICOs

• break down long-standing organisational divides, promoting seamless care
• offer better co-ordination of care with transfer to community settings as described in the White paper of January 2006
• are a progression from a programme of commissioning that is based in practice which already challenges Primary Care to extend service provision (and refer less)
• could be regarded as the service delivery mechanism for the ‘polyclinic’ concept

Development Criteria

Required

• Must serve a registered population but with much higher expectations.
• Developed from an established General Practice network with structural and governance arrangements for PBC in place
• Aim to integrate General Practice with at least one other care system;
Community; Secondary; Social

• Takes both clinical and financial responsibility and is accountable to the commissioning PCT for the health and well being of that registered population
• Accountable for outcomes delivered through a unified contract with the PCT
• Must adhere to National Choice and Competition policy when commissioning services not provided by ICO

Desired

• Choose to provide a range of services and contract with others for the rest, combining provision and commissioning functions
• Clinically-led comprehensive service with incentives to invest in health promotion and encourage more self care as well as providing diagnostics and treatment
• High performance to be incentivised through bonuses. Poor performance may face financial penalties. Transaction costs to be reduced through extended service provision.
• Explore managed care programmes, case management for LTCs, individual care budgets
• Incorporated as either;

A social enterprise/CIC
LLP
Ltd company
- to facilitate corporate working between care services in ICO
- allow for the employment of health, social, admin personnel
- manage budgets/accounts

Questions

Is there a critical size of population that an ICO should serve? e.g. < 50K may be too great a risk to unify contracts/budgets;  >100K may stifle development, restrict mobility and prompt a monopoly service.

How will ICO’s be regulated?

What is the role of the commercial sector in partnering or developing joint ventures within ICOs. (The risks and benefits need analysing)

What are the risk management arrangements within demonstration sites?

Dr James Kingsland
NAPC Chairman
August 2008

NHS Next Stage Review: LEADING LOCAL CHANGE

NHS Next Stage Review: LEADING LOCAL CHANGE

I am writing to update you on the progress of the NHS Next Stage Review. 

I was asked by the Prime Minister and Secretary of State for Health to lead the Review in July 2007.  My interim report in October set out a vision for a world class NHS that is fair, personal, effective and safe.

The Review has been led locally by clinicians in each NHS region.  Seventy-four local clinical working groups, made up of some 2000 clinicians, have been looking at the clinical evidence and engaging with their local communities.  They have developed improved models of care for their regions to ensure that the NHS is up to date with the latest clinical developments and is able to meet changing needs and expectations.

I am today publishing ‘Leading Local Change’ to set the context for these local visions and the principles which will guide their implementation.  We are also publishing new operational guidance (www.dh.gov.uk/changingforthebetter) as promised in my interim report in October, to help ensure that any changes are based on clinical evidence and are in the best interest of patients.  As part of this, we are making five pledges on change in the NHS, which PCTs will have a duty to have regard to: