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Benefits clinic can transform lives, says GP

The Government's drive to transform the management of chronic diseases will dramatically reduce GP workload, cut hospital admissions and save PCTs vast sums of money, two new analyses claim.

But while the RCGP welcomed the focus on chronic diseases in the new NHS plan, it said 'huge investment' in primary care to support GPs' work would be needed.

Active case management – for patients with the most serious and complex chronic conditions – could cut GP home visits in the over-75s by 53 per cent, out-of-hours care by 82 per cent and general appointments by 19 per cent, according to data presented at the

recent NHS confederation conference in Birmingham.

The analysis combined data from a range of case management pilots, including the London older people's service development programme and Evercare pilots. It predicted schemes could reduce hospital bed days in patients over 65 by 29 per cent and save PCTs up to £1.15 million a year.

While active case management focuses on patients at the highest risk of unplanned hospital admission (see diagram), the Government made clear in its NHS plan it wants to see proactive care for many more patients with chronic conditions. It will see new evidence from the Castlefield's practice in Runcorn, Cheshire – site of the initial case management pilot – as further support for the notion of 'disease management' for patients at medium risk.

The practice employed a dedicated part-time nurse to audit and co-ordinate the care of cancer patients and ran a similar scheme for patients with mental health problems.

Dr David Lyon, a GP in the practice and primary care lead for cancer at the NHS Modernisation Agency, said the scheme had brought large reductions in hospital admissions and reduced deaths in hospital by 50 per cent.

The results, reported at a recent agency conference, showed savings of £100,000 a year in decreased admission for cancer patients and £500,000 for mental health.

But Professor David Has-lam, chair of the RCGP and a GP in Ramsay, Cambridge-shire, warned the NHS had been 'bedevilled' by inadequate evaluation of schemes.

He welcomed schemes to manage chronic illness 'as long as they are not compulsory and can be tailored locally', but said they would require 'huge investment'.

By Emma Wilkinson

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