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Why occupational medicine would work out well for GPs

The Government's much-touted community matrons scheme is in tatters after researchers concluded it would have barely any effect on hospital admissions.

US-style active case management ­ hailed by the Government as the answer to spiralling emergency admissions ­ is unlikely to cut admissions by more than 1 per cent, an evaluation has found.

But ministers have vowed to press ahead with the multimillion pound scheme, which aims to introduce 3,000 matrons by March 2007.

GPs said the evaluation, which examined pilots of the Evercare case management system, was evidence they were already doing a good job with vulnerable patients.

Lead researcher Professor Martin Roland, director of the National Primary Care Research and Development Centre, said: 'If reducing admissions was the main reason for starting up the schemes then we have a problem. This is a very expensive intervention and the NHS needs to think very carefully about what it wants to get out of it.'

The RCGP said the evaluation 'vindicates the long-running concerns we have had about community matrons, fragmentation of primary care and privatisation by stealth'.

GPC chair Dr Hamish Meldrum said matrons were unlikely to be cost-effective, but admitted it was 'unrealistic' to hope the Government would now scrap the scheme.

Ministers are targeting a 5 per cent cut in emergency bed days by 2008, which because of rising referrals is likely to require a 12 per cent cut in unplanned admissions.

But even under the most optimistic projections, admissions would not fall by more than 6 per cent, the Government-funded research found.

Professor Roland said claims made for active case management were based on the false assumption that there was a stable group of high-risk patients who were visiting hospital year on year. He said it was 'disappointing' the Government was pressing ahead with community matrons on the basis of US evidence from nursing homes that was not relevant to the NHS.

But primary care tsar Dr David Colin-Thome insisted: 'I'm reasonably confident we'll hit the target.'

Evercare's active case management targets patients over 65 who have had more than two unplanned admissions over the previous year.

A home-grown alternative to Evercare

Dr Donal Hynes has set up a rapid assessment system for high-risk patients within primary care which he says is far more cost-effective than using community matrons.

In the scheme, unplanned admissions are flagged up automatically by an electronic referrals management centre. Once patients leave hospital, they are monitored by district nurses until they are judged to have stabilised. Dr Hynes, medical director of Somerset Coast PCT and a GP in Bridgwater, said community matrons were 'an expensive and cumbersome way' of cutting admissions.

'In our system we take patients into a community hospital for assessment and try to get them home with a high level of support.'

By Emma Wilkinson

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