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Why Evercare will struggle over here

I believe it will still be the district nurses ­ or their equivalents ­ who will do the hard work for patients

In the interests of progress, one of our best local district nurses has disappeared from the frontline. She is to become a chronic disease nurse specialist, in a scheme based on the 'Evercare model' introduced from the United States. The aim of schemes like these is to keep elderly people with multiple conditions ­ the so-called 'frequent fliers' ­ out of hospital. And with some 80 per cent of an individual's health costs incurred in the last year of life, supporters of the model sense a potential way for cash-strapped PCTs to save money.

However, cynics might say: 'It's another centrally-inspired round of rationing in the community.'

In any case, we are about to find out how functioning with one less nurse affects team morale in the interest of our top 40 'frequent fliers'.

Dubious economics

The man we have to thank for this is Alan Milburn, who as Secretary of State for Health signed us up to this one back in 2002. Trials in some parts of the country, have suggested with some dubious economics that if you target the frequent fliers for the preceding two years you can save cash.

This might well be true in the US, but in many UK pilots ­ mine included ­ a lot of these patients become expensive because they are dying from multiple co-morbidities. So the end effect of Evercare is to transfer care, and costs, to the community and the patient.

The idea comes from the managed health care environment of the US. Evercare is the brainchild of UnitedHealthcare, a private insurer ­ and one of the big players champing at the bit to gain access to the UK health 'market'. UnitedHealthcare has a chequered history and has paid several big public fines for a variety of alleged frauds in the US. In total, the firm has incurred more than $7 million of fines to settle charges it was involved in patient and health provision irregularities. These claims have ranged from overcharging state health care funds to using unregistered doctors.

Making money from patients

Academics have also pointed out that managed care funds tend to restrict their activity to patients they can make money from, rather than patients with complex health and social needs.

No one has been able to demonstrate in the long run that managed care will actually save money in the UK. Many NHS budgets operate with an administration cost of 25 per cent, while managed care firms in the US operate with administration costs about 10 points higher.

I think the Evercare model will struggle in the UK. The model has been introduced untrialled, evaluation is sketchy, there don't seem to be any clear aims and objectives and the global remit seems to be one of rationing. Long-term care charges have shunted means-tested costs to patients and carers. It would be nice to find out if anyone in Whitehall will ever care about the vulnerable. And in the end, it will still be the district nurses ­ or their equivalents ­ who do the hard work for patients.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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