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GP heart failure burden to rise

By Nigel Praities

GPs will be expected to take on more heart failure patients to clear space in hospital, according to a strategy document released by the NHS this week.

The document from the influential NHS Institute for Innovation and Improvement identifies a number of ‘high volume' areas where hospital admissions and length of stay can be reduced.

Pulse exclusively revealed last year that the Institute was planning on shifting the follow-up burden of checks to GPs, with indicators looking at reducing new to follow-up ratios and readmission rates.

The Institute's High Volume Care Programme has already made inroads into bed-days and admissions rates for mental health and emergency care, recommending schemes such as a traffic light system to identify when patients are ready for discharge.

This programme will now be extended so that more heart failure patients are managed in the community by GPs. Mark Jennings, priority programme director for delivering quality and value at the NHS Institute, said care outside hospital should be promoted more:

‘Cardiac care does not necessarily need to be in a hospital setting. There is this perception that the hospital bed adds some value but it doesn't. For instance, diagnosis may be in hospital but then patients are referred back to be managed in primary care,' he said.

But Dr Ahmet Fuat, a GP in Darlington who runs a specialist heart failure clinic, warned GPs needed much more support if more heart failure care was shifted to primary care.

‘The vast majority of patients would be much happier in the community, but we have to be able to resource that and I am not sure that we are. I don't think there has been any extra money for practice-based commissioning to support that,' he said.

His clinic has reduced admissions for heart failure by 50%, but only due to multidisciplinary team-working and specialist nurse assistance, he said.

Other plans include encouraging more self care and community care for children and young people after an emergency admission and decreasing the recovery time of diabetes patients, with better control of their condition encouraged in hospitals.

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