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Hospital follow-up cuts leave GPs to pick up pieces

By Nigel Praities

EXCLUSIVE: GPs are having to deal with a rising tide of complex cases as hospitals cut follow-up care to meet new NHS benchmarks, a Pulse investigation reveals.

Hospitals reduced follow-up appointments by 12% between the first and fourth quarters of 2007, in preparation for a new NHS indicator promoting the shift of care to GPs.

The proportion of day cases and number of bed-days saved both rose over the time period as managers sought to minimise hospital stays.

But Pulse has uncovered evidence that the plans may be backfiring, with latest figures showing a 12% leap in emergency readmissions over the first three quarters of 2007 – the first period readmissions within 14 days were measured.

The statistics reopen the debate over the Government drive to move care out of hospitals.

They follow a shock 16% increase in GP referrals to outpatient departments in the first quarter of this year, with some experts blaming early discharge in order to meet the 18-week referral-to-treatment target.

Figures obtained from the NHS Institute for Innovation and Improvement show the average number of follow-up appointments for each new case fell from 2.5 in the first quarter of 2007 to 2.2 in the final quarter.

The figures are the first reported since the measurement was introduced by the institute as a new NHS indicator in January 2008, after primary care tsar Dr David Colin-Thome called for postoperative checks to be shifted to GPs.

But the proportion of patients requiring emergency readmission within 14 days of discharge rose from 4.2% in the first quarter of 2007 to 4.7% in the third quarter.

Dr Jonathan Fielden, chair of the BMA consultants' committee, said there was huge pressure on trusts to ‘push people out early'.

‘There are multiple reasons for an emergency readmission, but it is one of the markers suggesting an organisation should look at its discharge policy.'

Dr Graham Archard, former chair of the RCGP, said readmissions were traumatic for patients and GPs and needed to be managed better in hospital, since continuity of care was often disrupted.

‘If there was a way of readmitting patients and ensuring they remained with the same team, I wouldn't have such a problem with it,' he said.

Dr John Ashcroft, a GP in Ilkeston, Derbyshire, and vice-chair of Derbyshire LMC, said NHS targets were distorting the goals of care.

‘There have been cases in my area, especially in the colder months, when patients who really shouldn't have been pushed out of hospital, have been,' he said.

But Pulse has learned the Government will push for an even greater shift in services from secondary to primary care, after an evaluation of its Care Closer to Home demonstration sites found they provided cheaper services and speedier access than hospitals.

Researchers looked at the impact of 30 pilots launched in 2006, in which hospital services were substituted with community care, by making more use of GPSIs and increased provision of community diagnostic and treatment facilities.

Waiting times for community services were just 6.7 weeks, compared with 10.1 weeks in hospital, and patient satisfaction with access was higher.

A DH spokesperson said: ‘Analysis of emergency readmission rates suggests there is no single explanation for fluctuations. More care than ever is provided outside hospital settings, including some follow-up care. This is what patients want – personal care closer to home.'

Patients being put at risk of emergency readmission after being 'pushed out of hospital too early' Patients being put at risk of emergency readmission after being 'pushed out of hospital too early'

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