GPs told, cut unplanned admissions by a fifth

By Lilian Anekwe

Exclusive: GPs are to be told they must reduce unscheduled hospital admissions by a fifth by the end of 2013 as one of a series of brutal Government targets to keep hundreds of thousands of patients out of hospital each year.

Ministers have drawn up a drastic efficiency programme that requires GPs to deliver a 10% cut in A&E attendance and the flagship 20% reduction in unscheduled admissions, while working with hospitals to cut length of stay by 25%.

In an exclusive interview with Pulse, Sir John Oldham, a GP and the Department of Health's national clinical lead for quality and productivity, said the dramatic reductions had to be achieved and that there was ‘no plan B'.

The DH believes the targets can be hit through reforms to the payment by results tariffs due to be announced next month and use of a new ‘clinical dashboard' to identify patients needing preventive care. But it would not confirm whether it would tie GP pay to achievement of the targets by writing them into the planned commissioning outcomes framework for consortia.

Sir John said: ‘A 20% reduction in unscheduled admissions and 25% reduction in length of stay have been achieved in bits of the NHS. The model of care will lead to that if we implement it in full.'

He said a model of care had been developed based on evidence from around the world, involving risk profiling of patients with long-term conditions, multidisciplinary neighbourhood care teams with one person having ultimate responsibility for each patient, and transferring knowledge to promote self care.

He said GPs in Bolton, where the clinical dashboard was piloted on IT systems, had cut both A&E attendances and unscheduled admissions in the last financial year, by identifying those patients who were over-using urgent care.

‘The GP dashboard gives a real-time update of patients' use of urgent care, so you can identify them and modify their behaviour. We're moving towards 10 pioneer sites to test what happened in Bolton before we roll it out.'

In the Bolton pilot, one practice cut A&E attendance by 17%, while in pilots elsewhere, GPs cut unscheduled admissions by 20% in one area and admissions from COPD exacerbations by 46% in another, Sir John said.

Sir John admitted ‘there is no plan B' if GPs failed to meet the goals by the end of 2013, but said ministers had agreed to overhaul the tariffs to strengthen the incentives for keeping patients out of hospital. ‘These will have to be achieved. If we don't grasp hold of management of long-term conditions and the urgent care that goes with that, we are all up a creek without a paddle,' he warned.

But Dr Beth McCarron-Nash, GPC negotiator and a GP in Honiton, Devon, said admissions and attendances were out of GPs' remit and ‘wholesale changes' to the NHS would be required to reduce them.

‘There are no quick fixes – these things take time. This will necessitate a shift in funding. Tweaking the tariff is not enough,' she said. ‘But to pluck figures out of the air and set a timescale for change that is ludicrous mean it will be impossible to create these changes.'

Professor Martin Roland, professor of health services research at the University of Cambridge and a GP in the city, said the DH should be wary of extrapolating from any one of its pilots too heavily: ‘I think it would be very unwise to extrapolate results from one area – they are not necessarily achievable nationally. These do not sound like bad ideas, but the evidence that they can achieve reductions on a grander scale is very sparse.'

20% - cut in unscheduled hospital admissions by end of 2013
10% - cut in A&E attendance by end of 2013
25% - reduction in length of hospital stay by end of 2013

Source: DH QIPP programme

Read Pulse's editorial on this story: It looks like targets are back with a bang