This site is intended for health professionals only

At the heart of general practice since 1960

How we reduced appointments by a third for socially isolated over-75s

Jo Malpass describes how a new staff member helped her practice reduce the number of slots booked by lonely older patients

We were concerned about social isolation among our older patients, who were booking appointments because of loneliness. We wanted to offer these patients a more personal and proactive service, and the Prime 75+ project (run by consultancy service Prime GP) provided a tailored solution.

The project was commissioned by NHS South Warwickshire CCG in December 2014, and we were one of four GP surgeries included in the trial. We have three partners and 6,300 patients and now have a dedicated over-75s co-ordinator, employed by Prime GP, who has a background in working across the local authority and voluntary sector. She is with us for two full days a week and works alongside clinical and reception staff, helping to identify over-75s who are lonely, socially isolated and, in some cases, frail.

She sees patients in the practice and their homes, then finds shared interests between them and looks at what activities are on offer in the community that they can attend.

We’ve seen a 33% reduction in the number of GP appointments among patients seen by the over-75s co-ordinator

Where there are gaps in activity provision, the practice manager and over-75s co-ordinator work together to organise activities in the community and practice that are appropriate to patients’ needs and wishes – anything from first-aid courses to tea parties.

The over-75s co-ordinator has had contact with more than 690 patients across the four practices since the scheme was launched last January – some 43% of the overall population of over-75s. She has conducted more than 280 initial assessments and a fifth of those she has assessed have been found to be lonely.

The CCG fully funds the scheme, which costs £50 per head of the target population, although this will be reviewed in March.

Challenges

Initially it was a challenge to convince GPs that the project would reduce their workload, and would not increase the pressures they already faced. However, the over-75s co-ordinator post is now highly valued by participating practices and everyone can see that potential health crises have been avoided.

Results

The model is simple, yet is having a positive impact on isolated and lonely older patients, reducing their dependence on the healthcare system and consequently freeing up GP time.

We’ve seen a 33% reduction in the number of GP appointments among patients seen by the over-75s co-ordinator. For example, one patient attended the practice 102 times in 2014; this figure halved in 2015.

Now the appointments that are booked are justified by medical need, providing confidence to GPs, and ensuring patients are prioritised when they do need medical attention.

We are seeing a monthly trend in the reduction of hospital admissions among over-75s. Since March 2015 there has been a flattening or reversing trend in activity compared with the increasing trends in 2014.

More importantly, the project has brought significant benefits in terms of patient satisfaction. It has also raised the profile of the practice in the community and given everyone involved a feelgood factor.

If this initiative was rolled out on a national basis, and if a 10-minute consultation costs an average of £35, a CCG with a population of 200,000 could save 88,800 GP surgery appointments and £3.1m.

Jo Malpass is practice manager at Pool Medical Centre, Studley, Warwickshire

Rate this article  (4.83 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (20)

  • Well, at least one group of doctors has the balls to do whats in their interests and the interests of their patients.

    Unsuitable or offensive? Report this comment

  • snore
    who cares
    idle threats made and action cancelled at the last minute
    the BMA couldn't organise a piss up in a brewery

    Unsuitable or offensive? Report this comment

  • GPs will never unite like that. Unfortunately, many GPs do deserve to be punished for their arrogance and total disregard for their profession, patients and younger colleagues. Maybe Hunt is right?! Maybe the ONLY solution is to demolish the NHS in order to get rid of the "rot". Yes, I am talking about you cardigans.

    Unsuitable or offensive? Report this comment

  • Yes by all means go ahead and strike .... since your career records have already shown a 'blacklisted' mark from the previous strike! Not that the BMA will back you up now, but do you have a back up plan...like, erm... cancelling at the last moment?

    Apart from pretending/protesting for the camera's and 'throwing your rattle out' , have you any insight into a Viable/Sustainable solution....Jeremy Hunt does for sure ! See you in Oz

    Unsuitable or offensive? Report this comment

  • Bob Hodges

    'Black list' my arse.

    90% of UK specialties will soon have more vacancies than applicants. Certainly for consultant posts, and soon for training posts.

    They can't afford to blacklist anyone, because there's no one to do the work otherwise.

    Paying doctors might be more expensive than they like, but it's significantly cheaper than having no doctors.

    Unsuitable or offensive? Report this comment

  • Pack your bags and leave uk- please do not forget to turn off the lights- saves money!!

    Unsuitable or offensive? Report this comment

  • The Tories know that the NHS is failing because of lack of funding ( it's available if they got their corporate chums to pay their taxes properly ) and need someone to take the blame . Enter the JDs who have been skilfully goaded into striking and become the perfect scapegoat. Far better to allow a natural death and let those tory jeremies to take the rap. Please take it easy don't "bust a gut " and read the DNAR form.

    Unsuitable or offensive? Report this comment

  • This is a set-up don't fall for it. If you're seen putting a shotgun to the head of a corpse you'll be done for murder.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Extraordinary sentiments......
    Separate one event from another .
    The fact that some are not happy with the outcomes from Saturday LMC conference should not interfere the spirit of supporting these youngsters standing up for themselves . They have well over 90% ballot mandates.
    The campaign is always meant to be long and should be sustained.....

    Unsuitable or offensive? Report this comment

  • Why not an all out strike. JD's are looking weaker and weaker. government 2 JD 1. losing the battle boys....losing it.

    Unsuitable or offensive? Report this comment

  • For junior doctors just stay on 'strike' and only provide emergency care - until the management sacks the whole lot- of course they will not- assuming you are paid in full while striking.

    Mr Hunt's NHS is unsafe -

    Unsuitable or offensive? Report this comment

  • I agree with Vinci. This group of doctors has guts and leadership. We could learn from them.
    Good luck comrades!

    Unsuitable or offensive? Report this comment

  • An all out strike for as long as it takes is the only thing that will have any effect .Anything else will play into Hunt's hands.

    Unsuitable or offensive? Report this comment

  • So why were the teeth taken out of this strike by not stopping all services? No-one will feel any pain so nothing much will happen. Well done BMA!!!!
    So dumb as dragging this career death out will mean more and more juniors will just leave or make alternative plans.

    Unsuitable or offensive? Report this comment

  • Peter Swinyard

    We must support the juniors.
    Industrial action in general practice is harder than for an employed workforce such as the juniors. We are (theoretically) self employed - and most salaried doctors are employed by other doctors - so whom would be strike against.
    The LMC Conference on Saturday was Bowdlerised by the lawyers terrified of putting BMA funds at risk and lacked the fire and energy the delegates felt - not even to be allowed a soap box was a real misjudgement.
    We must harness the energy of the severely pissed-off GPs to gain a contract worth having in a service worth staying at work for.
    Our patients deserve better - and so do we.

    Unsuitable or offensive? Report this comment

  • I agree with the possibility that this is an engineered strike but to do nothing in the face of such provocation is to invite further attack. The Govt has anticipated a wishy -washy response and so far have been proved right . Sharks need a good sock in the eye otherwise they will bite your arm off . " You're gonna need a bigger boat "

    Unsuitable or offensive? Report this comment

  • Such schemes are great. The problems is the 'managers' wont see a defined measurable outcome so you can guarantee the funding will be cut.

    Unsuitable or offensive? Report this comment

  • £50 per head of target population??
    That's a lot!
    It's £78 to fund GP care for a whole year?!
    were confounding factors eliminated from comparative data the year before?!
    I agree it's a very important area, vulnerable, needy and complex group......and social prescribing everywhere is big news!
    Surely these patients could be identified and this work done more cheaply and I'm dubious about the 3.1 million savings extrapolation! Dragons Den would have this for dinner!!!!

    Unsuitable or offensive? Report this comment

  • Very well done you should be proud of your selves. Hope this will catch on around the UK.

    Unsuitable or offensive? Report this comment

  • £50 per head of target population??
    That's a lot!
    It's £78 to fund GP care for a whole year?!
    were confounding factors eliminated from comparative data the year before?!
    I agree it's a very important area, vulnerable, needy and complex group......and social prescribing everywhere is big news!
    Surely these patients could be identified and this work done more cheaply and I'm dubious about the 3.1 million savings extrapolation! Dragons Den would have this for dinner!!!!

    Unsuitable or offensive? Report this comment

Have your say