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GP care home support ‘cuts deaths and workload’

By Lilian Anekwe

Providing GP practices with the support of geriatricians improves management of elderly patients in care homes and reduces healthcare ‘crises', a pilot study reports.

Its findings come after a Pulse survey of almost 900 GPs found as many as 80% felt they lacked sufficient support or resources to manage elderly patients in care homes safely.

The pilot in Leicester trialled shared management of patients in residential homes between GP practices and community geriatricians – and found the system cut out-of-hours call outs and consultations, deaths and hospital admissions.

The pilot offered GP practices access to comprehensive geriatric assessments, care planning, rapid written feedback and a telephone advisory service.

After six months, out-of-hours consultations fell by 16% and requests for visits by 37%, and hospital admissions were reduced by more than half.

The total cost of hospital admissions fell by 60% - from £140,000 to £55,000, and the average cost of hospital admissions fell by 16%, from £2,529 to £2,119.

Dr Richard Wong, a consultant geriatrician at the Leicester general hospital who worked on the study, said: ‘One of the GPs was thinking about moving on because the workload generated by requests for reactive care was becoming insurmountable. But after identifying patients in need of care planning their workload was reduced.'

‘Practice-based commissioning is a way of people taking this up locally, but if it is going to take a wider hold it's got to be done centrally and mandated by the Department of Health.'

In January, a DH-commissioned report found every day seven out of 10 residents of care homes are exposed to at least one medication error, and called for better communication between primary and secondary care.

Dr Helen Hosker, a GPSI in old age medicine in Manchester, said: ‘These patients are very time consuming and there's no extra resources to deal with them, and I think patients suffer as a consequence.'

‘This is exactly the kind of model that will offer GPs the support they lack. I certainly feel this is something that deserves expansion.'

The study will be presented at the British Geriatric Society spring meeting in Edinburgh next month.

Pulse's Manifesto for General Practice demands improved access to geriatricians and specialist nurses, and better resources for GPs, to drive up standards of care home management.

Health secretary Andy Burnham told Pulse: ‘Certainly, more specialist nursing, and GPs' access to that, is very much on our agenda.'

Dr Helen Hosker: this model will give GPs the support they lack


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