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GP practice paid to divert lonely patients to charities

A CCG has awarded £23,000 to a GP practice to pay a full-time staff member to divert patients who are ‘wasting’ GP appointments to local charities instead, Pulse has learned.

The Mission Practice in Bethnal Green in east London has already partly self-funded the role on a part-time basis for one year but is now able to hire the ‘community services networker’ on a full-time basis after being handed the funding from NHS Tower Hamlets CCG.

The practice estimates that it sees 500 patients a year - some of whom come more than once a month - who do not actually require medical care but are having other problems relating to loneliness and social isolation, debt or housing issues.

In total, the scheme has cost the practice £8,000 for the first year, when the service was available 16 hours a week, which was also helped by a £4,000 charitable grant from a local church. The practice will now add a further £5,000 to fund the scheme full-time this year alongside the £23,000 CCG investment.

Richard Walne, a former NHS Foundation Trust director and now business development director for OneMedicalGroup was asked by the GP practice to provide strategic business advice for the project. He estimated that across Tower Hamlets there may be 15,000 patients a year that do not need a GP appointment but still book several.

He added: ‘This has enabled the practice to have a third sector coordinator that frees up GP time. The person will care for all the people that make appointments with a GP when they are not really needed, in the sense that they don’t have a medical problem. They are very often people who have reached the end of the line and are very desperate for some kind of help, but the kind of help that can be provided better by the multiplicity of local charities that are around.’

‘What we can do is to direct people to use those charities, to use those third-sector organisations that are best equipped to deal with the problems that people have, ranging from debt issues, mental health issues, disability issues and so on where they are not getting the support they need from the local authorities.

‘It is picking up all those people who are really wasting clinical time and making sure that they get looked after by people who are better qualified to deal with their problems.’

Dr Louise Vaughan, a GP at the practice, said the initiative was hopefully temporary so that patients would know in the future where to go for help in the community instead of thier GP practice.

She said: ‘The lady we have hired has been able to see these people one on one for 20 minute appointments to help them work out what services would be most appropriate for those people, and even accompanying them sometimes, so it has been really successful.’

‘People go to see a GP now because when 150 years ago they might have gone to see their priest, when people have problems they go to see the doctor because there isn’t really anyone else who is socially appropriate to see. Especially in London where the biggest issue people have is loneliness. There is a huge amount of social isolation and not a lot in terms of a community.

‘We know as GPs that people turn up and say “I’ve got a headache” or whatever, but that is not the underlying problem and some people are just struggling with life.’

‘I completely agree we shouldn’t be seeing those people if we are just being doctors, but they are coming to us so it is our responsibility to make sure that their needs are met. In the long-term we want to see them going to community services first and us second.’

Readers' comments (10)

  • Why not try such interventions? It's a lot less money than the £millions earmarked for Telehealth with no more evidence.
    Life problems have been medicalised -promoting Wellbeing and social integration might reduce medicalisation, overprescribing, overinvestigating and improve health related behaviours.

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  • Vinci Ho

    NHSE/CCGs are passive , short sighted and with no vision on what is needed for the future of the health services. Not every GP practice can afford to pay this money upfront to 'prove' something will work.
    Signposting and genuinely integrated care(with universal definition) are feasible only if the attitude and behaviour of NHSE and hence CCGs are different from now to provide the proper support and investment to practices to do their jobs, the 'tools' , in essence . Only if this happens will the so called co-commissioning have become meaningful.

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  • Vinci Ho, when reading your comments I do wonder if your confusion of attitude/behaviour with levels of resource is related to your seemingly universally negative view of all institutions that are not GP practices.

    Perhaps worth remembering then that it is unlikely that the squeeze on primary care is due to the attitude or 'lack of vision' of these anonymous people you like to blame, or their doing so just for the fun of it.
    Neither NHS England nor CCGs would fail to fund practices more if they had more money, but there just isn't the money in the system to keep funding at previous levels (though I am sure many would question whether those previous levels were ever sufficient either).

    Perhaps what may be more helpful is a well reasoned argument and campaign for more funding for primary care.

    Sadly though that does not deliver the same dramatic effect. It is however more likely to be effective.

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  • We are about to start a scheme very similar to this in Leeds which has been commissioned by Leeds West CCG and will allow GPs to signpost patients to project coordinators who will then make sure they access the right voluntary sector group / service

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  • "but there just isn't the money in the system to keep funding at previous levels"
    In other words the funding for general practice will never return to a reasonable level.
    I think most of us accepted a bit of a squeeze on funding across the NHS and were willing to accept a few years of stagnation. What has happened, however, is that the total funding has dropped so far and so fast alongside massive increases in expectation that it is no longer possible to do what is expected.
    There either needs to be a drop in expectation to reasonable levels, or funding that makes it possible to do the job.
    Projects like this May well help workload and give patients more appropriate help and are to be praised ( if they work!)
    They are not, however, going to solve the problem and comments like manager 9.35 are complacent and damaging. Hand in the air shrugging is not acceptable. There is not enough money in the system to pay for every cancer patient to get every available medication, so they are sadly told it is not funded. We must start saying the same in general practice and cannot continue to be expected to do everything within the limited resources we have.
    What would you ( manager 9.35) suggest we stop doing?

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  • Took Early Retirement

    I agree with Vinci Ho. I have seen more than a decade wasted by "managers" of the then PCTs, who moved under TUPE regs to NHSE, that would do ANYTHING they could to avoid GPs being paid for doing extra work. It just wasn't in their ethic. So, we STILL have NHSE refusing to give GPs a LES for minor injuries, but at the same time whining about the cost of unnecessary ED attendance.
    This is why many of us are sceptic.

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  • Vinci Ho

    For what is a man, what has he got?
    If not himself, then he has naught.
    To say the things he truly feels;
    And not the words of one who kneels.
    The record shows I took the blows -
    And did it my way!
    Thank you , Frank

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  • I think that this and many other issues have existed for years however GP’s haven’t been forced to address them until now. The reason for their now having to be addressed is due to the lack of money and resources in primary care which is trying to improve efficiency to keep heads above water. Therein lies the catch 22. The lack of money is creating the need to address these issues but there's no money with which to do so. GP's aren’t wrong to complain but the NHS can only spend what it has to spend. The issue is essentially prioritisation and the only way that can be achieved effectively is for everyone to work together. That was the idea behind CCGs but it isn’t working because they do not have the freedom to commission in a way that would enable this to be achieved. I was recently approached by a GP in my area asking about redundancy costs for his staff because he thought the practice would be folding in 12 months. If I told you what area that is you probably wouldn’t believe it! I really believe that the government simply has its head in the sand over this and believe that GP’s are crying wolf. I don’t believe there’s a big privatisation plan, I simply think that the government is ignorant and going to look pretty foolish when there is no primary care in 18 months’ time!

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  • Vinci and NHS manager have their rightly held views. What is evident to me is the many stress points that we are all familiar. We must stop apologising for wishing to be well paid for a professional job that sees our practices providing millions of appointment a day to an insatiable appetite. The politicians are feeding this by pounds of GP staff flesh. We are down to the bear bones and are about to fail to keep up with 'servicing' the eat all you can buffet for £80/pt/yr. that's ridiculously cheap. The system needs more money or less work. (The latest less bureaucratic QoF is BS too. Adding back the unplanned admission service is a joke, more paper time less patient time.)

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  • When I was social Care Commissioner for East Kent we piloted a Community Link Worker project in east Kent 5 years ago. The aim was reduce GP time which was non-medical and connect patients with existing community or social care resources( as well IAPT CBT) .It was so successful it is now Kent wide and funded by social care and public health and provided by Porchlight a local charity. We must stop seeing patients problems as either medical or social when most of the time they are both and have holistic needs.

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