GP Enterprise Awards 2012: Improving Quality and Productivity

WINNER: Dykes Hall and Deer Park Medical Centres, Sheffield

Dr Steve Thomas and his team
Dr Steve Thomas and his team

This practice reduced unscheduled admissions in the over-75 age group by 20% using a multi-disciplinary team approach.

Their results compared with a 7.7% reduction across Sheffield's city-wide clinical commissioning group, and created efficiency savings of £101,249.

Dr Steve Thomas said the practice was sited in the west of the city, where 7.4% of the population was aged 75 years or above and were responsible for 25% of emergency admissions.

They used the EARLI/PARR system (Emergency Admission Risk Likelihood Index/Patient at Risk of Re-hospitalisation) to identify at-risk over-75s and to systematically address issues identified via a multidisciplinary team approach.

The scoring system allowed the stratification of patients according to risk, and small numbers of identified patients were allocated to GP partners to perform a notes review prior to the initial meeting.

This assessment identified whether they were already allocated to an appropriate health professional, and if they needed a more holistic assessment, including falls risk and cross-referencing with QOF and long-term conditions.

What the judges said:

This practice spent a lot of time and effort creating this very practical scheme, and has provided hard evidence that it works.’

They would then identify the appropriate health professional to carry out the work - for example, even a patient with a high-risk score could still be mobile and able to attend surgery and would therefore see the practice nurse. Appropriate community-based clinical pathways, such as continence or falls, would also be used. At the next meeting, one or more members of the multi-disciplinary team would briefly recap on patients to check whether they had moved up or down the 'care ladder'.


For example, some may have initially been allocated to the community matron but due to interventions, moved back to practice care, with the practice nurse taking the lead for the long-term condition.

They found that many patients on the over-75 list were also on, or potentially on, the end-of-life/palliative care list, so the palliative care meeting was formally merged in to the process.

Dr Thomas, said: 'The multidisciplinary team approach has engendered excellent team-working relationships, which has extended to consultant colleagues joining.

'We now have a consultant geriatrician and a social worker around our table and participating in our "virtual" rounds.

Another key player is our practice manager, who acts as team co-ordinator.'


Highly Commended

Ilkley Moor Medical Practice, Ilkley, West Yorkshire

This practice established a musculo-skeletal assessment and treatment service team that improved quality and productivity across 15 local practices.

The service is located at five locations, delivering 10 sessions per week, including evening appointments, throughout the year. It is staffed by four GPSIs, an extended scope physiotherapist and podiatrists, with a central administration team based at Ilkley Moor Medical Practice.

After its first year, the service is able to demonstrate efficiencies and significant savings in musculo-skeletal management within primary care, and a reduction of referrals into secondary care.

What the judges said:

It’s great to see primary and secondary care working together in this way, solving problems and improving services within existing resources.’



Highly Commended

Chester GP-led Health Centre, Cheshire

This GP-led multi-disciplinary team has delivered a hospital at home scheme covering conditions such as community acquired pneumonia, COPD, decompensated heart failure, acute confusion, and urinary tract infection.

If a GP or community matron needs to admit a patient in an emergency, they have the choice of referring to the hospital at home team. If the patient agrees, the assessment begins in two hours.

Investigations include blood tests with a 60-minute turnaround, near patient arterial blood gases, ECG and X-rays. The care is equivalent to admitted care, including IV antibiotics, subcutaneous fluids and oxygen.

The service was commissioned by NHS Western Cheshire and launched in December 2011. The next development is to admit patients directly from A&E and the ambulance service, and overall they expect to treat 1,460 patients a year who would otherwise have required unplanned admission.

What the judges said:

This is a very patient-centred service that brings together lots of agencies in a great example of real teamworking.’

How to vote for Dykes Hall and Deer Park Medical Centres as the overall winner

 Voting is now closed

The winning practice will receive £4,000 and you will be entered into a prize draw for a fantastic iPod Touch. The closing date is 3 September 2012.

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