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GPs told to cut hospital use by 15% in a year

By Lilian Anekwe

Exclusive: GPs are facing demands to deliver unprecedented reductions in hospital activity over the current financial year, with NHS managers setting targets for cuts in admissions of 15% or more by next April, a Pulse investigation reveals.

Primary care organisations are going far further than even the Department of Health had planned, and demanding GPs deliver major cuts in hospital activity in less than half the time set out in the national QIPP programme. GPs warned the plans were unachievable and that there was a risk they could damage patient care.

In November, Pulse revealed Sir John Oldham, DH national clinical lead for quality and productivity, had warned GPs that by the end of 2013/14, they would have to cut unscheduled admissions of patients with long-term conditions by a fifth and help reduce A&E attendance by 10% and length of stay by 25%.

But responses from 120 PCTs and health boards under the Freedom of Information Act show they have earmarked an average 15% reduction in unscheduled hospital admissions in patients with long-term conditions by April 2012 alone. They are also targeting average reductions of 31% in A&E attendance and 26% in length of stay by the end of this financial year.

PCOs are aiming for average savings of £2.4m each. NHS Milton Keynes is targeting a 40% reduction in unscheduled hospital admissions, and NHS Camden a 25% cut in non-elective admissions, among patients with long-term conditions over the current financial year.

Sir John's projections for reductions in hospital activity rely on GPs implementing a new model involving risk profiling of patients with long-term conditions, appointing a single person to be responsible for each patient and promoting self care.

Our investigation reveals PCOs hope to use a range of methods to lower admissions, including integrated care, urgent care redesign, telehealth and hospital-based 'virtual wards'. Some are employing community matrons to try to deliver major cuts – even though a major Nuffield Trust review in March found no evidence such schemes were successful at reducing admissions – and could even increase them.

NHS North Staffordshire has called in private providers to implement admission avoidance strategies, including Aetna Health Services to provide the Connected Care Programme, BUPA to offer risk stratification tools and Tunstall Healthcare to deliver a telehealth scheme.

NHS Suffolk has a 'roving GP' who attends ambulance 999 calls, and has asked practices to ‘call patients following A&E attendance to discuss why they used A&E rather than their GP'.

Trusts defended the level of cuts. NHS Telford and Wreakin said: 'QIPP should not be viewed solely as a savings plan – it is a redesign and service improvement plan to avoid costs.'

But GPs said they doubted PCOs would be able to achieve the scale of secondary care cuts they had earmarked.

Dr Richard Vautrey, GPC deputy chair, said: 'It's not surprising PCOs are setting such targets given the challenging financial targets they've been set. But to actually achieve them is quite another thing. It's a laudable aim, but they need to put in place safe alternatives and this takes time and resources.'

Dr Andrew Mimnagh, chair of Sefton LMC, said: 'There's a scheme locally to pay nurse practitioners to sit in casualty talking to habitual reattenders. It's not got a snowball's chance in hell of cutting admissions.'

The DH said it was 'encouraging' PCOs were driving up quality. But it added the deadline for its own QIPP targets had been extended to April 2015.

GPs told to cut hospital use by 15% in a year