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GPs follow ambulances on 999 calls to reduce admissions

GPs in Worcestershire are being called out at the same time as paramedics for non-life-threatening 999 calls, in an attempt to reduce hospital admissions.

NHS Worcestershire, in conjunction with the three CCGs in the county, has implemented the scheme in which a GP is called out alongside West Midlands Ambulance service at its busiest times.

If the call does not warrant a hospital admission, then the GP is left to deal with the patient.

The 27 GPs involved in the scheme are employed by the PCT at locum rates for the times they work with the ambulance service. The scheme costs around £17,000 a month, the PCT said.

The GPs have been called out to around 180 patients since its launch in early October, the PCT’s medical director, Dr Jonathan Leach told Pulse.‘In the main’ these were patients who would have been admitted to hospital were the scheme not in place.

Dr Leach, a GP in Bromsgrove and the pioneer of the scheme, said: ‘I met the chief executive of the ambulance service last week and he said “can we have more of it?”

‘The hospitals like it because it keeps patients away from hospital when appropriate; and we think it is good for clinical care because where appropriate we are able to keep patients at home rather than transporting them to hospital… The CCGs are well onside with this.’

He said he didn’t yet know how this affected admission rates, compared with other parts of the country. ‘We have an older population than the rest of the country. Many of our patients have stomach pains and have phoned 999.’

However, local primary care organisations in the West Midlands have contacted NHS Worcestershire to find out more about the scheme, Dr Leach added.

He said: ‘We tried putting GPs in A&E but we don’t think that works. What this is doing is bringing caring closer to the patient.

‘Our hospitals are busy, just like everybody else and we are trying different ways to improve the care and keep patients out of hospital. And, as a by-product, we think it is cheaper.

‘If they have kept one patient out of hospital during their shift, they have overpaid their wages. It would have cost us about £40k (per month) if they had gone to hospital.’

A cutting-edge GP scheme has already kept more than 100 emergency patients out of hospital in only two months.

The so-called GP with ambulance service has resulted in 155 people being seen by doctors since it was launched on Friday, October 5.

Of those 999 patients 134 (86.5 per cent) were kept out of hospital, treated in their own homes, in nursing homes or wherever they needed attention rather than taking up a hospital bed or an ambulance.

The GP is either called out to an emergency by the ambulance control room, attending alongside paramedics, or by paramedics if they feel the person could be better cared for in that way.

This not only frees up the ambulance crew to attend another, life-threatening emergency but also eases pressure on Worcestershire hospital beds, where demand has been up to 14.5 per cent higher than it was at the same time last year.

The scheme, which is scheduled to run until March, has been devised by Dr Jonathan Leach, a Bromsgrove GP and medical director for NHS Worcestershire, as part of the drive towards care closer to home.

A GP works with ambulance crews between lunchtime and early evening seven days a week but two GPs work on bank holidays and weekends, which tend to be busier.

GPs have so far helped patients with breathing problems, chest pain, diabetic problems, head pain and those who have fallen.

Dr Leach said: “I met the chief executive of the West Midlands Ambulance Service NHS Trust and the view was that they would like us to continue and do more of it.

“We’re able to provide a great range of services to patients in their own homes and frequently we can refer them to other community resources.

“It keeps patients out of hospital but if they need to go to hospital that’s absolutely fine.

“But many patients don’t need to go and it’s better for them to stay away from hospital. As far as I’m aware this scheme is a national first and other clinical commissioning groups are now looking into this. We think it’s working. We think it’s cheaper and it’s providing a better service. Everybody I’ve spoken to thinks it’s brilliant.”

The scheme is funded jointly by NHS Worcestershire and the three county clinical commissioning groups that are scheduled to take over the purse strings in April.

The project costs about £17,000 a month to run and each GP involved has a mobile surgery in their own vehicle. Strategists believe schemes such as this could slash hospital admissions by up to 10 per cent.

Readers' comments (8)

  • so are these GP who are called out specially hired for this scheme?? and how much are they paid? or are GPs taken out of their routine sessions to attend and then who deals with the slots lost at the practice?? who deals with the patients who then have to wait ??who deals and gets blamed for their complaints??

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  • Atul, it says a lot that your first question is how much are they paid. Surely if the scheme is working then avoiding unnecessary admissions to hospital is a good thing and reflects patient-centred care. Maybe the slots lost at the practice, if it is GPs who are taken out, can be allocated to other memebrs of the clinical team? More innovative schemes like this (especially in Worcestershire) will be needed so let's see how things progress and look at patient outcomes and satisfaction.

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  • £17,000 for 27 GPs 24/7 for one month = GPs on call for less than £1 per hour - I hope the NHSCB/Government is looking at this for the next contract negotiations!

    Seems that we should decommission 999 - have access to cheap salaried GPs (working from home or the local supermarket 7 days a week - with minimal business overheads) who can then phone ambulances if they are actually needed! We certainly don't need another remote telephone service to get between GP's and patients ... oh(!)

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  • Atul / Anonymous

    Read the article! The GPs involved are paid at locum rates. The scheme does not run 24/7, but from lunch until early evening. Only one GP works at any one time, with the exception of bank holidays, when there are two.

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  • Its only been going since October, I sense that after a while the punters will get wise and dial 999 for utter utter trivia so that the nice GP can tend their every need at home.

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  • It seems to me that general practice is in a sad state when the prevailing comments relate to re-numeration or how the "punters" will find ways to abuse the system. Surely the first point of contact for this group of patients should be their GP team.
    A retired ( just ) GP

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  • Its just as sad that you have to state you are retired

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  • I'm not sure that I understand the last comment. Surely retirement comes to us all ?

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