Exclusive GPs will be paid £30 per patient to go through hospital lists and identify those that could be discharged and managed in primary care, in a radical CCG plan to cut the case-load of consultants and save cash.
In a QIPP initiative hoped to ease the pressure on hospitals and generate savings for the NHS, participating GPs will receive a one-off fee of £30 per patient from for carrying out a review of all patients being managed by the diabetes and respiratory medicine teams and seeing if they could be discharged.
The scheme – run by Tameside and Glossop CCG – and due to begin in September has been expanded after a similar intiative run last year for cardiology patients cut lists by 19%.
The CCG hopes to save £42,000 – and an additional £273,000 after reviewing all patients by re-commissioning the diabetes service – with the scheme at Tameside Hospital NHS Foundation Trust, one of the trusts placed under ‘special measures’ following the review of mortality rates conducted recently by NHS deputy medical director Sir Bruce Keogh.
The scheme comes after GPs were called into hospitals and other secondary care facilities to register patients and treat them on wards and demonstrates that CCGs are exercising their commissioning power to pay GPs to shift more care in the community.
A spokesperson for Tameside CCG said the response from GP practices to the scheme had been positive.
She said: ‘We ran the same exercise with our cardiology follow up outpatient list in 2012, resulting in almost all of our GP practices engaging in the project which led to a significant impact.
‘We have had a favourable response from our member practices to the diabetes proposal so far, and expect a high response rate once the work begins. We are also in discussions to look at similar projects with our respiratory and ENT patients.’
A QIPP report from Tameside and Glossop CCG, seen by Pulse, said: ‘This follows a similar review in cardiology during 12/13 which saw 19% of patients discharged back to the GP.
‘This review of diabetes precedes the commissioning of a new diabetes service to ensure only appropriate patients are transferred over.’
Dr Shane Gordon, chief officer of NHS NE Essex CCG and a GP in Colchester, Essex said it made sense for specialists to be left only with the most difficult cases.
He said: ‘It’s about using the specialists for the group of patients that most need it. If their waiting rooms are clogged up with patients that could be seen in primary care then moving those people who are less complicated to be cared for by their GP means resources are being used efficiently.’
Dr David Jenner, the general practice network lead at the NHS Alliance and a GP in Devon said it was a ‘reasonable’ idea, but warned GPs would need ongoing support to care for the patients discharged back to primary care.
He said: ‘We’ve done something slightly different locally by introducing specialist diabetic nurses and virtual clinic with diabetologists, so there are different ways of cracking an egg.
‘I’d also review what support GPs need to look after the patients. What primary care will need is something recurrent as well as a one-off fee for the review. They should negotiate a fee for taking back the patients when they can, and the ongoing support to make that happen.’
He added that while this could work for patients with diabetes, there are certain areas like rheumatology where it is more integral the patients are managed by specialists.