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How commissioning will affect your practice

North Bradford PCT has been operating practice-based commissioning for four years. All of its 12 practices are involved and the scheme covers outpatients, elective surgery, locality services and acute care.

Some 6,000 appointments a year that would have been handled by hospitals are now dealt with in primary care, including by 32 GPs with a special interest.

Before it set up the scheme, the PCT's analysis of urgent care revealed 10 per cent of acute admissions were caused by 189 patients and cost £1 million. Just 500 patients accounted for 20 per cent of acute admissions.

Trust chief executive Dr Ian Rutter, a GP in Shipley, said GPs realised hospital procedures they had regarded as 'free' cost a lot of money.

'When people realise costs are inappropriately locked in hospital beds we begin to see a more integrated approach to diagnostics and case management, because funds will allow us to do it,' he said.

Examples of new care pathways include:

·Urology ­ referrals are triaged by GPs with a special interest and there is a cystoscopy service in primary care

·Musculoskeletal ­ GPwSIs work with specialist physiotherapists to triage and treat patients, with referrals to orthopaedics reduced by more than 50 per cent

·ENT ­ majority of patients managed by three GPwSIs

·Drugs misuse ­ GPwSIs head up a community-based service in primary care

·Neurology ­ most patients are managed in primary care

Patients typically wait two weeks to see a GPwSI.

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