Category: 2.3. Home visits: duty clinicians and collaboration with other practices
St Helens borough in Merseyside had one of the highest emergency admission rates in the Strategic Health Authority area. There were 150 admissions per 1,000 population. This compared to the PCT target of 120 or fewer.
Patients would call their practice in the morning, hoping for a home visit, but find out that their doctor was fully booked for the entire surgery. In some cases, this resulted in a delay of over three hours from time of the request to the visit being made. If the condition deteriorated, or they thought it did, patients or their carers frequently called an ambulance or went to A&E.
There was therefore a need to reduce emergency admission rates. So, nine practices in a St Helens commissioning consortium devised a shared acute visiting service. This employed a GP dedicated to home visits.
Now, patients who request an urgent home visit call their practice and speak to their own doctor or a practice nurse. The medical professional assesses whether or not the patient needs to be seen. If so, the doctor from the acute visiting service will be sent. Three quarters of patients are seen within an hour, with the appointments lasting up to 20 minutes.
There are now 12 practices involved, and the results have been 'phenomenal', says lead GP Dr Shikha Pitalia. 'We launched this scheme in December 2006, and since then we've reduced emergency admissions by 30%. We had support from the PCT in the first year, but now the scheme is self-funding. It generates savings from the emergency admissions avoided.'
The benefits are significant, for the practice as well as the patient.
'Just one or two urgent requests for home visits can significantly reduce the availability of GP appointments. Sharing a home visit doctor gives us back three appointments a day, on average,' says Dr Pitalia.
The system borrows the infrastructure of the local out-of-hours provider, who recruited a doctor with knowledge of the local referral care pathways to provide an acute visiting service. Regular monitoring of the service ensures that clinical standards are maintained.
Shikha Pitalia
shikha@ssphealth.com
