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GP screening and care plan programme for older patients ‘increases NHS costs’



An NHS programme that involved GPs screening older people at risk of hospitalisation and providing them with care plans increased NHS costs instead of reducing them, a new study has shown.

The research into the ‘Southwark and Lambeth Integrated Care (SLIC) Older People’s Programme’ found that GP practices using screening to identify the health needs of patients over the age of 65 increased both outpatient attendances and elective admissions.

This was likely due to ‘identification of unmet needs’ as a result of the ‘enhanced primary care activities’, said researchers from the universities of Cambridge and Exeter and the London School of Economics.

Those behind the study told Pulse that CCGs in a number of regions are introducing similar schemes and warned it is likely they could also end up costing the NHS more money.

Local GP leaders said resources used for the programme – which ended in 2016 – ‘could have been better used supporting tried-and-tested general practice services’.

In south London, researchers estimated the cost of the whole programme was £7.4 million, including £2.9 million on infrastructure, which was funded by Guy’s and St Thomas’ Charity, NHS England and Health Education England South London. 

According to a final report on the programme by King’s College London, £2.49 million was spent on ‘integrated care’ costs, including £1.02 million on holistic assessments and £0.51 million on integrated care management costs.

The SLIC programme was a case management programme for older patients, that involved GPs carrying out holistic assessments, looking at physical health, mental health and social care needs, as well as wider social aspects, such as housing and benefits issues.

Those patients found to be at risk of hospitalisation were then provided with integrated care plans and a named healthcare professional – which could be a GP – to coordinate and manage their care.

Practices were originally expected to carry out assessments for half of all residents aged 65 and above in the two boroughs – but this target was later reduced after some primary care staff ‘felt interventions were imposed on them and that they lacked time to engage with the programme’, said the study.

The study, published in BMJ Open, said the programme had led to a small reduction in A&E attendance, but there was no effect on emergency admissions overall.

It added: ‘There was clear evidence that despite an overall reduction in volume of elective care compared with what would have been expected, the two interventions increased both outpatient attendances and elective admissions and, as a result, led to significant increases in NHS costs.’

The report noted that for every holistic assessment, costs increased by £126 in outpatient attendance and £936 in elective admissions.

Additionally, for every patient that had a care plan in place, the cost of outpatient attendance increased by £576, and by £5,858 in elective admission costs.

Professor Martin Roland, from the University of Cambridge, who led the study of the SLIC programme, said: ‘What was interesting was the effect of the intensive case management when they identified older people at risk of needing hospital admissions, that their costs were quite a bit increased – not from emergency care, but from elective care, from referrals to hospitals as elective admissions.

‘Although we couldn’t prove it, as we weren’t set up to look at that, my assumption is it’s quite likely because of identifying unmet need in people and then appropriately dealing with it.’

He added: ‘CCGs are introducing schemes similar to this in a number of areas to try and provide better support for older people but what the evidence shows to date is that they do not reduce the costs of emergency admissions – and they might have the effect of increasing elective admissions and therefore increasing costs of care.’

Lambeth LMC vice chair Dr Neil Vass said: ‘The Southwark and Lambeth Integrated Care Older People’s Programme took up a lot of leadership time from across local health and social care services, along with significant spend, including on consultancy.

‘The resources could have been better used supporting tried-and-tested general practice services, which can be relied upon to keep people healthy in the community, meaning fewer of them need hospital care.’

But Dr Clare Gerada, a GP in south London and new co-chair of the NHS Assembly – tasked with overseeing the delivery of the NHS long-term plan – stressed there would always be some patients who require hospital care.

She said: ‘We know that GPs are looking after sicker and sicker patients in the community so whatever initiative is put in place, we’re still looking after patients who will need, at some point, a hospital admissions.

‘We need to improve the ability for GPs to deliver continuity of care and heading up multi-disciplinary services, which is what a good general practice is.’

The programme is part of a number of similar nationwide integrated care schemes aligned to NHS England’s policy of reducing emergency admissions and moving care out of hospitals.

However, in 2013, a study into an integrated care pilot in North West London reported no significant changes in reducing emergency admissions.