A proactive approach to the care home population

The creation of a nursing service-level agreement between the Robin Lane medical centre practice and Leeds West primary care trust has driven a much-needed transition from a reactive to a proactive approach to managing the healthcare needs of the care home population.

Last year, we engaged the PCT in setting up a service-level agreement for nursing homes that aimed to provide proactive and preventive care, as well as tackle unscheduled admissions.

Under the agreement, each GP takes responsibility for a set number of care homes and has weekly scheduled visits. There is also an annual review visit to each care home by a nurse practitioner. The cost to the PCT was £25,000.

The result has been improved communication between care home and practice staff. This includes practice staff providing education on prevention and treatment of osteoporosis, MRSA and falls prevention.

It has also generated reductions in emergency hospital admissions - an average of 28 per cent in the last financial year and significantly larger reductions in the last five months of the year.

From October 2005 to March 2006, the practice saved the PCT around £200,000 and, based on data analysis for the first six months of this year, we anticipate saving around £400,000 in 2006-07.

We will also shortly be rolling out the model we employed to our housebound/borderline housebound population then to the rest of our population who are high accident and emergency attenders.

Samuel Forbes is managing partner at Robin Lane Medical Centre.

Find out more

Click here to read the Robin Lane Centre’s care home report on its PCT service level agreement

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29th June 2006
Cutting excess bed days

Avoiding hospital admissions and reducing stays are ongoing priorities for primary care and acute trusts.

In Sheffield, where the average cost of a medical admission for a person over 65 is £2,465, a new project is already showing results.

Work led by South East Sheffield primary care trust with Sheffield Teaching Hospitals foundation trust, on behalf of the city’s four PCTs, is saving substantial sums by reducing the number of admissions, excess bed days and, consequently, medical outliers - medical patients on non-acute wards.

Since September 2005, Sheffield PCTs have saved £2.4m by reducing non-elective admissions by 1,200 - 2.1 per cent.

Excess bed days were down by 6 per cent in the last quarter of 2005-06, a saving of £1m, expected to rise to £4.1m in 2006-07.

The project has centred on partnership-working with the acute trust, making clear the financial incentives for all and linking in to the patient pathway.

Mutual trust and the low-key education of acute clinical staff by senior community matrons around treatment packages led the way for community nurses to work inside the hospital’s bed bureau. Their role is to consider alternatives to admission following calls from GPs.

Emergency care practitioners respond to paramedics called to nursing homes to help assess whether community treatment is appropriate. That includes nurse specialists caring for patients with cardiovascular and pulmonary disease, with consultants providing support and advice over the phone. The problem of excess bed days is being tackled by offering community services. Scrutiny of potential admissions and long-stay patients who could benefit from community treatment has resulted in a fall in medical outliers from 95 at this time last year to 10 in May this year.

More information

Delivering quality and value: focus on productivity and efficiency
NHS Institute for Innovation and Improvement, June 2006

Improve healthcare by reducing unnecessary emergency admissions - Hewitt
Department of Health, March 2006

Avoiding and diverting admissions to hospital – a good practice guide
Department of Health, January 2004