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By making sure that people see primary care staff first, we could make a savings of at least 500,000.

Ray Guy Practice Manager

Managing demand

Ray Guy, a practice manager in Liverpool, has been using the Dr Foster Intelligence tool for more than two years and describes it as "very useful."

Recently, data has shown a great increase in A&E attendance over the last two years. Twenty-five per cent more people have been using A&E than had been previously. The problem most likely lay in the proximity of the centre to the local population.

"A lot of our practices are fairly close - within 1500 metres - to the local hospital and in a socially deprived area. I think people tend to wander into A&E and treat it like a GP surgery. You hear suggestions that we need a culture change (about appropriate use of services by patients) but you can't change that culture overnight. So we want to re-educate people by taking the mountain to Mohammed, so to speak," said Guy.

Guy says the data from Dr Foster Intelligence's Practice and Provider Monitor tool (PPM) suggests that 10 to 15 per cent of patients could be using A&E inappropriately.

"By making sure that those people see primary care staff first, we could be making a savings of at least £500,000," said Guy.

Solution

"The PPM tool enables me to answer the two most basic questions: what services do we need to provide to the people in our community and who needs to go to hospital? Once that's known, you can create a community health system based on a prioritised list of things that you want to take out of hospital," Guy continued.

So far, the tool has helped establish trends of A&E attendance, which supports the development of a plan to situate a primary care unit within the A&E department. Guy is drafting the plan on behalf of the local PBC consortium. The 23 practices in the consortium care for approximately 100,000 patients.

Such a large number of patients being more appropriately cared for in primary care could make a huge difference to the local health economy.

"If you're ambulatory or can be wheel-chaired in, your first point of call should be a primary care professional, not be an A&E professional," said Guy. "This plan will allow us to place primary care professionals at the first point of contact. By immediately evaluating patients and deciding whether they need to see a primary care nurse or GP, X-ray or A&E should help us to immediately reduce our costs by half or more. At the moment, it's impossible to regulate the demand and therefore you can't control costs."

Outcome

Depending on the success of this pilot, the consortium may also examine models already up and running around other parts of the country in order to establish other methods of managing demand that may be suitable for local adaptation.

Guy is also using PPM to examine follow-up rates for musculoskeletal and ophthalmology patients.

"If you go into the fracture clinics, you'll see 12 new patients and 56 follow-ups. From personal experience, when I damaged my leg, I had an MRI and then a follow-up that consisted only of being told, 'Here's a pretty picture of your leg; it's wear and tear, you don't need to be seen again, cheerio.' And I thought, why can't that be communicated via telemedicine to the GP? If we could do, all I would have to do is make a phone call, and the receptionist could tell me. I could then get the details at my next annual check. That solution saves a lot of money. It's a consultation dealt with on the phone, compared to £85 for a follow-up. If you start doing a couple of thousand of those a year, think how much you can save."

Tool

Practice and Provider Monitor