Vanguards of care

3 June 2016

The NHS is searching for innovation to address the increasingly complex needs of patients and meet its targeted £22-billion efficiency savings in 2020-21. One area developing new approaches is primary care. On Monday, NHS Confederation, in the first of two reports on the Government’s new models of care, revealed that significant improvements are being delivered.

A variety of successful approaches are on show. West Wakefield Health and Wellbeing, a multi-speciality community provider, has used social prescribing – which refers patients to non-clinical services to address their wider needs – to improve the wellbeing of four in five patients using the service. All Together Sunderland, another MCP, which cares for almost 300,000 patients, has targeted its most at-risk patients to reduce emergency admissions for over 65s. Sutton Homes of Care employs GPs and care-coordinators to carry out health-and-wellbeing reviews – reducing A&E emergencies by 10 per cent. This is crucial for NHS finances, as recent Reform research highlighted that each appointment cost as much as six times more than a GP consultation.

This is a positive start to the vanguard programme, unleashed in 2014. The different approaches also vindicates the Government’s insistence on not pursuing a one-sized-fits-all approach. As Reform research highlights, there are many ways providers can deliver more effective care.

More services delivered within primary care could reduce A&E attendance even further. Lakeside Healthcare, based in Northamptonshire, offers an urgent care centre, which delivers 250 urgent appointments each day. Critically, each costs less than a third of the price of an equivalent A&E visit. With up to 60 per cent of A&E activity capable of being delivered by GPs, the NHS could save £1.1 billion a year from such models.

A new workforce is required to deliver these services. Experts interviewed for Reform‘s report explained that 50 per cent of appointments currently provided by GPs could be delivered by other clinicians. If nurses delivered the 15 per cent of appointments dealing with minor ailments, the NHS could save over £700 million a year. Pharmacists and physiotherapists are also well-placed to deliver other care: one-third of GP appointments are for musculoskeletal problems.

These new care centres should also embrace technology. In 2016, only seven per cent of people use online booking facilities, despite its near universality. Sophisticated triaging systems are already saving the NHS money, and patients time: one system developed across London would deliver savings of £250 million per year if the proportion using it matched the number of people who use the internet each day. Video consultations, over Skype, for example, are 40 per cent quicker than face-to-face meetings, excluding waiting times.

The NHS Confederation report shows that the future is bright for primary care. Using such approaches as a stepping stone to a more radical future would deliver an NHS capable of meeting the care needs of tomorrow’s population. One GP in Sutton summed up the benefits: “I find it rewarding to be able to properly care for end-of-life patients and now have more time to do so.”

Alexander Hitchcock, Researcher, Reform

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