Dr Charles Alessi explains how his practice generated huge savings with its new paediatric urgent care clinic – with no help from the PCT
Our practice has always prided itself on understanding the needs of our population, but even we have been astounded by the success of our urgent care clinic for children.
Within a year we have drastically changed the behaviour of our patients, with substantial reductions in A&E attendance for children on our lists both in and out of hours.
We did this with no extra funds from our PCT and the usual level of encouragement from NHS managers (in other words, none).
Finding a gap in our service
The Churchill Medical Centre is spread over two sites with around 15,000 patients. Despite being close to some of the most affluent neighbourhoods in south-west London, we cover one of the capital's most deprived areas. The ward has the largest council estate in the borough and a very mixed population, with a large proportion of children and young families.
We have always tried to offer a complete service. We were one of the first practices to open on Saturdays and are now open seven days a week to ensure our patients get the health care access they require.
But in late 2008, we started to look at our attendances in children's A&E and found a gap in the service we provided. We noticed that although we were open late every day, we did not seem to see the large variety of urgent presentations in children we would expect after midday. This was particularly surprising as we saw a whole variety of presentations in the mornings.
One of the explanations was that we are close to the local hospital, which has an excellent reputation and was ensuring its services were well publicised.
We decided to introduce a dedicated urgent service for children and improve access in the afternoons and early evenings.
Setting the clinic up
We were already open from 8am to 8pm on weekdays and so the task involved making small alterations to what we did, rather than developing an additional activity stream.
By rebranding an existing GP-led clinic held in the afternoon as a paediatric urgent care clinic, we were able to ensure the new service cost almost nothing.
We asked our patients which would be the most appropriate times. The urgent care clinic now runs from 4.30pm to 7pm Monday to Friday.
We also made special efforts to publicise our service by contacting our patients, particularly those who had used A&E. The message we wanted to get across was that it was not necessary to go to the hospital as there was an alternative that was at least as convenient.
We made every effort to ensure children were seen very quickly and also made sure our patients were aware of the advantages of being seen by practitioners they knew and trusted, rather than in a larger institution where nobody knew them.
Results of the clinic
The results in terms of attendances at the local A&E have been nothing short of sensational. We hadn't expected to see an immediate impact, but in a year there has been nearly a 40% decrease in in-hours attendance at A&E for our registered patients under the age of 16. And although our clinic is not open out of hours, the benefits seem to be carried through from in-hours, with a 30% drop in attendances.
What is also extraordinary is that a significant number of patients have to travel further to be seen at our practice – further than to get to A&E.
The resources we have saved are considerable, running into six figures – not only in reduced attendances but also downstream in lengths of stay and outpatient attendances. We also have a population that is happier and feels more secure in the knowledge that their practice is there when their children need urgent care.
Conclusions
We have been surprised by the results of this clinic and it really shows that even small changes in delivery can have significant effects upon patient flows.
By understanding our practice population and their specific needs, we were able to make a significant difference to our local health economy – although we did not expect attendances at the local A&E to drop as significantly as they did.
Do not wait for the PCT to come to you to make change. We made this change without any significant extra cost.
Dr Charles Alessi is a GP partner at the Churchill Medical Centre in Kingston upon Thames, Surrey
Useful resources• NHS Institute for Innovation and Improvement. Focus on: emergency and urgent care pathway for children and young people. www.institute.nhs.uk/quality_and_value/introduction/
quality_and_value.html
• Primary Care Foundation. Urgent care: a practical guide to transforming same-day care in general practice. www.primarycarefoundation.co.uk/page9/page19/files/
gp-urgent-care-report.pdf
