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Avoiding Unplanned Admissions: Pro-active case finding and care review for vulnerable people

Read codes

13Zu. At risk of emergency hospital admission
8CV4. Admission avoidance care started
67DJ. Informing patient of named accountable general practitioner
8CSB. Admission avoidance care plan agreed
8IAe1 Admission avoidance care plan declined
8CMG3 Review of admission avoidance care plan
8CT2. Admission avoidance care ended
8H2..% Emergency hospital admission

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Guidance

From Page 10, the full document can be found found here:

The "At risk of emergency hospital admission" code can be used by practices to identify those patients who they may wish to consider including on their register. These patients may not require immediate case management, but practices may find this helpful for consideration of which patients would benefit from proactive care planning in subsequent quarters.

The "Admission avoidance care started" code will be used to identify the patients on the case management register.

The "Admission avoidance care ended "code will be used to remove patients from the register.

The "Informing patient of named accountable general practitioner" is the same code as per the contractual requirements for all patients aged 75 and over to have a named GP. Patients added to the register in the first quarter, should be informed of their named accountable GP by the end of July 2014. Any patients added to the register in-year should be notified within 21 days of entering on to the register.

The three care plan codes will be used to identify those patients on the case management register who have agreed or declined a care plan, as well as those who have had a review. Patients who have declined a care plan may still remain on the case management register (and count towards the two per cent) if they still wish to receive other elements of the enhanced service i.e. telephone access, named GP and care coordinator etc. It is important to note that patients declining the care plan must be done so via informed dissent and not solely due to a patient not attending an appointment.

The " emergency hospital admission" codes will be used too identify those patients who were admitted to hospital. These codes should be used to help identify any patients on the case management register, who have been admitted to hospital and who should be contacted to co-ordinate delivery of care.

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Calculation of achievement

Payments for this ES will be split into five components, totalling a maximum of 2.87 per registered patient (see table 8). For purposes of payment the contractor's registered population (CRP) will be as at 1 April 2014 or it will be the initial CRP if the practices contract str=arted after 1 April 2014.

Table 8: Summary of payments, amounts and payment due dates

Payment Percentage of total funding Per registered patient (total 2.87) Payable (no later than)
Component 1 45% 1.29 31 July 2014
Component 2 20% 0.57 30 November 2014
Component 3 10% 0.29 28 February 2015
Component 4 10% 0.29 31 May 2015
Component 5 15% 0.43 31 May 2015

Manually submitted or automatically extracted data (where available and applicable) will be used to trigger payments, alongside successful completion of the relevant sections of the reporting template.

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Prepared By Jean Keenan