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New models of general practice reduce hospital demand, data suggest

New GP care models being tested by NHS England are starting to reduce emergency admissions and GP referrals to hospital, data have suggested.

The North East Hampshire and Farnham primary and acute care system (PACS) vanguard said GP referrals have fallen by 6% to date in 2017/18 compared with the previous year.

They said this came alongside a decrease in emergency admissions of 0.5% and a reduction in occupied bed days in hospital of 7.5%, citing ‘integrated care teams’ as the reason.

Speaking at last week’s King’s Fund Annual Conference, clinical chair of NHS North East Hampshire and Farnham CCG Dr Andy Whitfield said: ‘We are really slowing demand with everything that we are doing.’

The strategy adopted by the vanguard, which incorporates four CCGs and 87 member practices, includes actions to ‘prevent ill health and promote self-care’, ‘strengthen local primary and community care’, and ‘improve services for patients in a crisis and those who need specialist care’.

The latter includes extending the availability of social care services – which operate from 9am to 8pm – and introducing a new ‘interface between hospital care and primary care’, which sees hospital consultants supporting locality hubs or GPs working in hospitals.

Speaking to Pulse, Dr Whitfield said 80% of patients reported a ‘very positive’ experience when treated by new integrated care teams, which are based around GP hubs with 30,000-60,000 patients.

Dr Whitfield told Pulse tha the although the type of primary care at scale introduced through their programme was ‘achievable in all areas’, the model must be based on ‘local circumstances’.

Dr Whitfield said: ‘We developed our ideas with the local community, our clinical leads and managers to meet the specific health and care needs of our residents. We then tested these new models of care locally.’

Meanwhile, figures from NHS Sandwell and West Birmingham CCG suggested that GP practices within its multispecialty community provider (MCP) vanguard consistently saw fewer emergency admissions among their patients when compared with practices (across England) that are not working in new care model (23.6 per 1,000 population, compared to 24.5 in the second quarter of 2017/18).

The vanguard, which includes super-practice Modality, was also beginning to see a decline in A&E visits, according to its King’s Fund conference presentation.

New initiatives within the vanguard includes Modality GPSIs doing a variety of outpatient appointments, as well as physiotherapists rather than GPs seeing any patient presenting with a musculoskeletal problem.

Dr Naresh Rati, a GP in Birmingham and chief executive of the Modality Partnership, told delegates: ‘We are as a vanguard showing that our A&E attendances are much lower than the CCG average.

‘Emergency admissions, readmissions are much lower. When you are looking at emergency admissions, [the difference] is pretty stark in terms of the reduction.’

But he added: ‘Can I tell you what is the single-most intervention that has dropped that down in terms of emergency admissions? Is it our in-house primary care? Is it our specialist services? Is it the fact that we standardise our processes?

‘I couldn’t tell you – I can’t tell you which single intervention – but I can tell you that all of them for sure contributed to the dramatic improvements in the system.’