GPs will be the ‘drivers' of a set of services that pre-empt medical crises and monitor vulnerable elderly patients, said health secretary Andy Burnham.
The Partnerships for Older People Projects (POPPs) will be rolled out nationally after pilots in 29 sites around England were hailed as a success.
A DoH report into the pilots found they reduced hospital admissions and GP visits, improved care for elderly patients and saved trusts and local authorities cash.
The health secretary believes the existing health and social care workforce can deliver the service ‘without a great deal of resources'.
Mr Burnham admitted that GPs may need to be pushed by government as it had been difficult to get GPs involved in the pilot schemes. GPs would be encouraged to bid to deliver such services through practice-based commissioning, he said.
Many of the pilots involved community nurses and social services working together to identify elderly patients who are at a particularly vulnerable stage of their lives.
‘It's not so difficult to spot people who've recently had bereavement. That person really should receive more support in those few weeks afterwards to prevent them needing more services along the line,' said Mr Burnham.
‘If someone's had one fall, it's highly likely that they'll have another. It's about sharing data and identifying people at a vulnerable point,' he said.