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Together we can make a difference

As the NHS moves into a new phase, clinical commissioning groups are increasingly looking to work with secondary care to improve quality and efficiency. In Merton, we have had great success improving care for people undergoing hip and knee replacements.

As in most areas, people with chronic hip and knee problems often had a long wait between seeing a GP and seeing a hospital consultant. When they attended their hospital appointment, sometimes people didn't want surgery, weren't physically suitable or were not emotionally ready. We worked with the South West London Elective Orthopaedic Centre to fix these issues. GPs now use a standard assessment tool to decide whether to make referrals, and patients are seen by hospital specialists in an assessment clinic run in primary care. This does away with unnecessary hospital appointments and follow-ups.

Benefits for patients include care closer to home, a higher-quality service with no apparent organisational boundaries, improved satisfaction, greater choice and better understanding of the reasons for care decisions.

Benefits for GPs include more control of care, increased confidence about making referrals to appropriate services and a smoother transition from secondary care to community services.

Benefits for the hospital include improved communication, matching capacity and demand through smoother patient flows and significant improvement in the referral to surgery conversion rate (83%).

There has been a significant reduction in the number of secondary care consultations as a result.

Streamlining the service required time and effort, with a multidisciplinary team working across organisations. GPs were initially slow to make referrals to the assessment clinic and needed evidence that this new way of working was beneficial. We spent time training practice staff as well as GPs and repeatedly communicated the processes and benefits.

Determination and hard work were needed, but we have shown that a small number of practices can work together with secondary care to make a real difference.

From Sima Haririan

General manager, Merton Healthcare Practice-Based Commissioning Consortium