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GPs go forth

New models of general practice reduce hospital demand, data suggest

New GP care models being tested by NHS England are starting to reduce emergency admissions and GP referrals to hospital, data have suggested.

The North East Hampshire and Farnham primary and acute care system (PACS) vanguard said GP referrals have fallen by 6% to date in 2017/18 compared with the previous year.

They said this came alongside a decrease in emergency admissions of 0.5% and a reduction in occupied bed days in hospital of 7.5%, citing 'integrated care teams' as the reason.

Speaking at last week's King's Fund Annual Conference, clinical chair of NHS North East Hampshire and Farnham CCG Dr Andy Whitfield said: 'We are really slowing demand with everything that we are doing.'

The strategy adopted by the vanguard, which incorporates four CCGs and 87 member practices, includes actions to ‘prevent ill health and promote self-care’, ‘strengthen local primary and community care’, and ‘improve services for patients in a crisis and those who need specialist care’.

The latter includes extending the availability of social care services - which operate from 9am to 8pm - and introducing a new ‘interface between hospital care and primary care’, which sees hospital consultants supporting locality hubs or GPs working in hospitals.

Speaking to Pulse, Dr Whitfield said 80% of patients reported a 'very positive' experience when treated by new integrated care teams, which are based around GP hubs with 30,000-60,000 patients.

Dr Whitfield told Pulse tha the although the type of primary care at scale introduced through their programme was 'achievable in all areas', the model must be based on 'local circumstances'.

Dr Whitfield said: ‘We developed our ideas with the local community, our clinical leads and managers to meet the specific health and care needs of our residents. We then tested these new models of care locally.'

Meanwhile, figures from NHS Sandwell and West Birmingham CCG suggested that GP practices within its multispecialty community provider (MCP) vanguard consistently saw fewer emergency admissions among their patients when compared with practices (across England) that are not working in new care model (23.6 per 1,000 population, compared to 24.5 in the second quarter of 2017/18).

The vanguard, which includes super-practice Modality, was also beginning to see a decline in A&E visits, according to its King's Fund conference presentation.

New initiatives within the vanguard includes Modality GPSIs doing a variety of outpatient appointments, as well as physiotherapists rather than GPs seeing any patient presenting with a musculoskeletal problem.

Dr Naresh Rati, a GP in Birmingham and chief executive of the Modality Partnership, told delegates: 'We are as a vanguard showing that our A&E attendances are much lower than the CCG average.

'Emergency admissions, readmissions are much lower. When you are looking at emergency admissions, [the difference] is pretty stark in terms of the reduction.'

But he added: 'Can I tell you what is the single-most intervention that has dropped that down in terms of emergency admissions? Is it our in-house primary care? Is it our specialist services? Is it the fact that we standardise our processes?

'I couldn't tell you - I can't tell you which single intervention - but I can tell you that all of them for sure contributed to the dramatic improvements in the system.'

Readers' comments (11)

  • we havent any vanguard system despite this our referrals and a/e attendances have fallen
    There are many things not least that they are more proacttive as practices rather than the intervention that has worked

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  • AlanAlmond

    Our practice has low A&E attendance and low referral rates, we are in Birmingham and we aren’t part of a vanguard system. Despite this we get grief from the CCG for organising too many investigations! There are many ways to organise work...I’m not at all convinced with the ‘at scale’ dogma. We’re actually in danger of loosing the ability to offer certain services because funding is being lost unless we treat other practice patients and services are being taken away in favour of ‘multi practice community clinics’. The one thing this will defiantly accomplish is fragmentation of care and deskilling of practices which are currently providing these services perfectly adequately. Don’t believe the hype. The bottom line is the service isnt being funded adequately. It won’t be fixed with this constantl money wasting reorganisation - All firmly focused on making life easier for hospitals , moving work out to primary care and further reducing the money spent. It’s spin and bull. Were does this story come from. Who’s agenda is it serving? A well resourced bullshit factory powered by central government seeking to promote the latest fad in hospital focused primary care reorganisation. We need better funding. I am a total cynic.

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  • Is this really a surprise when these government agenda led service get more money and resources to work with.while the rest of us are being starved into compliance by the establishment corruption.

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  • In our area all GP surgeries shut are closed one afternoon a month as the CCG organises teaching. On that afternoon there are fewer hospital attendances, fewer admissions to hospital and I would suspect fewer referrals and less money spent on drugs.

    Does that mean we should all be closing at 1pm every day?

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  • Umm on how much more money?

    I'd applaud the scheme for making a very modest improvent (still, better then none) if it was done on parity to other areas.

    If they've done it with £X million more for vanguard schemes, it's disingenuous to claim success without RoI being analysed

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  • Have they any idea what their baseline variability is for any of the services they have studied?
    That it is less than last year means almost nothing, while it is nice to have a 'control' it is essential to identify how the 'intervention' differs from the control.
    Is this is an opportunity for academic GPs to establish some credibility? Is the college able to take an academic lead when it is so involved in the cheerleading?

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  • thought I read last month that smaller was better. I will believe this if it sustained over say 5 years. Our referrals go up and down. Same docs ,same patients. Each year CCG focuses on one of these high areas but then forgets about it the following year.

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  • Reduction in emergency admissions is "pretty stark": I'd call 0.9/1,000 (3.67%) reduction "pretty meaningless" actually. P value??

    As mentioned above, once you iron out natural variation, substitute servicing (eg a GPwSI doing a Consultant's clinic is still seeing those patients, with some duplication of workload), and pump-priming, these vanguards appear to be an expensive waste of scant resources.

    NHSE are absolutely desperate to show that they're of some use, otherwise how would you persuade the English NHS to adopt an American model of health care infrastructure?

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  • Why not publish a properly presented scientific paper, subject to peer review? Are we expected to simply swallow these headline figures?

    Furthermore, what were the health outcomes for patients?

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  • Regression to the mean - high referrals will tend to go down and low referrals tend to go up.

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