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Gold, incentives and meh

Trusts to hand GPs more complex hospital cases

By Nigel Praities

GPs are to be asked to take on a raft of complex medical cases in the first half of 2009 as PCTs attempt to solve their secondary care spending crisis, a Pulse investigation shows.

We can reveal there are widespread plans to accelerate early discharge from hospital and shift care into the community to reduce hospital workload.

Information gained under the Freedom of Information Act from 25 PCTs shows 72% are looking at new schemes to reduce hospital bed-days or divert more work to primary care.

Over two thirds plan to reduce the time patients spend in secondary care, reducing length of stay and follow-up appointments, with many currently in discussions with practice-based commissioning leads to achieve these reductions.

Nearly a third are looking at reducing ‘overperformance' in hospital departments achieving their 18-week wait targets, potentially making patients wait longer to see a consultant.

The revelation follows huge controversy over the rise in incentive schemes to reduce GP referrals, with dozens of PCTs forecasting their surpluses would be wiped out in 2009 after sharp rises in referrals for two successive quarters.

In one the hardest hit areas, Oxfordshire PCT said it was working on shifting more work in areas such as DVT and arrhythmia into primary care. It also has a ‘major project' to reduce ‘excess' bed-days, reduce overperformance on 18-weeks and is piloting a scheme to apply penalise trusts with high follow-up rates.

‘We are monitoring trust performance on new to follow-up ratio against their peer group and have associated penalties dependent on achievement,' a spokesperson said.

Walsall PCT plans a complete redesign of discharge planning to ‘minimise delays in discharges from hospital' while South Birmingham PCT has begun work on a scheme to ‘facilitate discharge planning' to reduce excess bed-days.

But Dr Sashi Shashikanth, a GP in Hillingdon in west London, which is planning a number of schemes, said his practice workload had already increased as hospitals discharged patients with unresolved issues, who then had to be re-referred.

‘Common-sense seems to have gone out the window. If community schemes can offer high-quality service closer to patients' home it is acceptable. But we have to ensure robust clinical governance arrangements are in place.'

GPC negotiator Dr Peter Holden said PCTs were too focussed on ‘crude statistics' rather than patient care. ‘What annoys me is patients seem to come very low - it is all about cost-effectiveness and the bottom line.'

GPs are to be handed a raft of complex hospital cases as PCTs try to cut secondary care spending

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