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At the heart of general practice since 1960

PCTs playing a fantasy numbers game

As their colleagues dust off CVs and prepare for a health bill-inspired exodus, the NHS managers who remain seem locked in a bizarre new game of budget-balancing one-upmanship – competing to see how low they can go.

As their colleagues dust off CVs and prepare for a health bill-inspired exodus, the NHS managers who remain seem locked in a bizarre new game of budget-balancing one-upmanship – competing to see how low they can go.

How else to explain the astonishing new targets primary care organisations are setting for the reduction of unplanned hospital admissions?

Just last November, we interviewed Sir John Oldham, the Department of Health's GP clinical lead for quality and productivity and the man charged with heading up its efficiency savings drive.

At the time, the ‘stretch goals' he disclosed – a 20% reduction in unscheduled admissions, a 10% cut in A&E attendance and a 25% reduction in length of patient stay by the end of 2013/14 – seemed hopelessly ambitious. ‘Ludicrous', was the word one GPC negotiator used.

But six months on, NHS managers appear to have taken those eye-watering cost-saving goals as a mere starting point. As our investigation this week shows, PCOs have decided they can actually reduce unplanned admissions by an average of 15%, A&E attendance by 31% and the length of patient stay by 26% – all in just a single year.

Merrily slicing a sixth off the total number of unplanned admissions in one year may make budgetary sense to a group of PCT managers staring into the abyss and throwing caution to the wind. But that kind of figure will prove impossible to achieve – and a lot of GPs and patients are likely to be alienated in the process.

That the NHS badly needs to find significant savings is not in doubt. Admissions will need to be curbed. But reading through PCOs' plans, there's the strong impression that faced with the need to make massive savings, managers have mandated huge cuts in hospital activity without any clear idea of how they will actually be achieved, or any sense of what the implications for patient care might be.

Is there an alternative? Well, rather than limiting the supply of hospital treatment through draconian admissions caps, managers would do well to look at more subtle, sustainable ways of limiting the demand.

A new study in the Emergency Medicine Journal looks in some detail at the different factors in primary care linked to a reduction in emergency admissions. These include a number of factors GP practices have little or no control over, such as patient demographics and the surgery's distance from hospital, but also some that they do – specifically, continuity of care and access to a preferred GP.

Continuity of care remains the great unmeasured value of general practice – cherished by GPs and patients, but sadly undervalued by the NHS's cold cost-benefit analysis. Yet here is evidence that doing general practice the right way can help the health service as a whole achieve the savings it so badly needs to make.

Instead of trying to achieve an unprecedented reduction in hospital activity through central diktat, GPs should be encouraged to simply do what they already do, better.

It's an appealing idea, but one which is unlikely to find favour with NHS managers. Here's hoping the new GP consortia are rather more receptive.

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