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At the heart of general practice since 1960

GPs lose nurses as US-style care pilots divert cash

GPs testing American health care

systems as part of a Government

drive to introduce them across the NHS have raised serious concerns about the projects.

Several PCTs are piloting systems run by United HealthCare and Kaiser Permanente which have lowered hospital admission rates in the US to a fraction of the level in the NHS.

The EverCare programme run by United HealthCare is designed to reduce hospital admissions for elderly patients and cut GP workload by dedicating nurses to elderly care.

GPs in some of the 10 trusts piloting the £3.5 million scheme said it was taking cash away from district nursing and other services and could increase their workload.

Dr Phil McCarthy, chair of Avon LMC, said PCTs in the region that were involved in the pilot were cutting back other services because the £73,000 budget per trust for the scheme did not cover nurses' salaries.

He added GPs in Bristol North PCT had told the LMC that cuts were being made to the area's district nursing budget.

'We are happy with the aims of the scheme but it's not been terribly well received by some GPs,' he said. 'It looks like we are having to rob Peter to pay Paul and we are also suspicious it will increase GPs' workload.'

Dr Surendra Kumar, a GP in Widnes, Cheshire, whose practice is participating in one of pilots, said the scheme had been inconvenient for patients and had led some to lose confidence in their GP's treatment.

He added: 'I can't just relax and accept these are teething problems.'

Dr Gareth Morgan, honorary secretary of South and North Cheshire LMC, said practices in Halton PCT had complained district nursing had been cut since it joined the pilot.

'It's basically a good idea but practices are suffering as nurses appointed to EverCare have not been replaced,' he said.

Meanwhile, Health Secretary John Reid is to deliver the keynote speech at a conference of NHS

managers in November on how they can learn from Kaiser Permanente.

The California-based organisation uses only one-third of acute hospital bed days and gives patients faster access to primary care services compared with the NHS using roughly the same annual budget and covering a similar population.

Dr Andrew Willis, a GP in Northampton and author of research into how Kaiser Permanente's principles fit with the NHS, said its clinicians in the US have far more nurse support. He said: 'In southern California there are 1.5 nurses per whole-time equivalent doctor. If you compare that with general practice they may have as much as three times as many nurses as we do.'

EverCare

Designed by US company United HealthCare to cut admissions of elderly people and prevent over-long hospital stays

Primary care takes charge of organising care for older people, using dedicated nursing staff to

pro-actively manage patients

Seeks to minimise multiple prescription drug use

Department of Health paying £3.5 million mostly in consultation fees to United HealthCare

Kaiser Permanente

Largest health maintenance organisation in the US, run as a not-for-profit business

Provides care through health insurance plans using its own hospitals and medical partnerships

Aims to 'blur boundaries' between primary and secondary care

Sees hospital admission as a failure of the system

­ aims to minimise it through chronic disease management and promotion of self-care

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