Our CCG has set up several services to enhance cost-effective patient care. One is a minor injury scheme, which incentivises practices to treat presentations that may otherwise require attendance at A&E or secondary care, such as musculoskeletal (MSK) injuries without suspicion of fractures, wound care and suturing.
What are the requirements?
The requirements are basic routine primary care facilities and skills.
Staff need a basic understanding of diagnosis and management of minor injuries.
Appointments are offered in routine practice hours (or extended hours, if there is demand) and are usually the same duration as normal appointments – 10 minutes.
The payment is per presentation.
What is the funding?
In our area, the current enhanced service employed by Leicester, Leicestershire and Rutland Partnership offers a fee of £15 per minor injury seen and £40 for stitching of a wound that would otherwise be seen in A&E. You can look up the Pulse Intelligence local services section to understand how much other areas are paying for minor injury services.
There is no time limit from the moment of injury to when the patient presents, so practices can claim for services even when the patient has tried self-help.
From a commissioner’s perspective, this is clearly a big saving compared with the typical costs of A&E attendance for a patient, which is around £138 irrespective of any onward or further care needed, or the severity of the injury, according to figures from the Health Foundation.
The scheme is also a good source of income for practices, and is satisfying for patients. On average, a GP who may see two or three of these minor injuries per six-session week.
Injuries that are eligible range from a small abrasion that may just need advice, to wound closures, burns, bruising and soft tissue injuries such as pulled ligaments. In theory, any minor injury is claimable, so long as the patient has not presented it to A&E already and the injury is within the scope of primary care (ie not major trauma).
In some circumstances, the number of presentations could be higher. In a practice of, say, five GPs, along with ANPs and nurses, the payments can add up to several hundred pounds per week.
How to staff the service
Providing this service is fairly straightforward, as it draws on skills already available in primary care – especially if you employ a GP with a special interest in urgent care or MSK medicine. For example:
• An MSK specialist GP can see soft tissue and sports injuries, advise on rehabilitation and liaise with physiotherapy.
• A practice nurse with a special interest in wound care can deal with simple lacerations and burns.
This also adds to the general practice skill base, because the GP will see interesting acute presentations, and maintain abilities and interests.
The patient is provided with better care than in A&E, at a fraction of the cost.
How to run it efficiently
All equipment needed is already available in primary care surgeries, so the service shouldn’t require additional expensive purchases.
Doctor and nursing appointments must be allocated to the service. Some practices use duty doctor and same-day urgent nurse slots.
The exact number of appointments depends on list size and population mix, but can reach 10-15 a day.
Ensuring the correct coding is an essential but straightforward task. Each consultation is coded to ensure data collection and payments (such as 9kb on EMIS Web).
If you don’t have the in-house experience, there are short courses available, such as GP minor surgery and basic wound care. The RCGP runs accredited courses to learn minor surgery and MSK skills.
It’s important to advertise your service to patients, to advise them to see the GP instead of visiting A&E for basic injuries. Emphasise that this doesn’t include fractures or complex injuries.
Signpost patients using the practice website, text messages and reception.
Your minor injuries service could also be the first step to building a more specialist service for your locality, such as an MSK and sports injury clinic.
Federated practices might be able to pool their skills and offer appointments during extended hours.
These actions require relatively little or no financial outlay, and can potentially be lucrative. At the same time, they provide high-level patient care and boost the practice’s reputation.
Dr Ralph Mitchell is a GP partner and specialist in sports and musculoskeletal (MSK) medicine practising in Leicestershire