GP nursing home service cuts hospital admissions by a third

Commissioning GP practices to provide dedicated support for patients in nursing homes could significantly reduce emergency hospital admissions and healthcare costs, researchers have found.

A support service delivered to four nursing homes in east London by GPs from a single practice led to a 36% reduction in emergency hospital admissions and a 53% reduction in bed days in hospital. The researchers estimate that the service could cut healthcare costs per nursing home resident by as much as £1,000 per year.

The east London GP practice, called Health 1000, delivered a seven-day-a-week support service from 8am to 8pm for patients across the four homes in a bid to reduce hospital admissions and improve access to general practice.

Researchers from the Nuffield Trust think tank compared data on 431 patients in the four homes covered by the scheme - run by the Health 1000 practice on behalf of Barking and Dagenham CCG - with 1,495 patients in comparable nursing homes. Both sets of patients had a mean age of around 84 and included many people with multiple long-term conditions.

The Health 1000 service offered a named clinician and key staff as contacts for each nursing home,  support for end of life care, medicines reviews, support from a geriatrician and acute assessments of patients by GPs without them needing to leave the nursing home.

GP nursing home service

Emergency inpatient visits to hospital per nursing home resident fell from 0.83 to 0.53 under the Health 1000 service, compared with a slight drop from 1.04 to 1 visit per person at the comparator homes. A&E attendances were almost static at the Health 1000 practices, but rose by 14% at other homes.

The researchers said the findings suggested that nursing home staff had been driven to 'risk averse behaviour' by poor access to GP services - leading them to send a higher number of patients than necessary to hospital.

The staff were also struggling with administrative workload because nursing home residents were previously registered with GPs at multiple practices, the researchers said.

Report author and Nuffield Trust senior research analyst Chris Sherlaw-Johnson said: 'When social care and hospital services are under severe pressure it is encouraging to have found a service that appears to show real benefits for nursing home residents and staff. This research shows how primary care may be able to take the burden off local hospitals as well as offering better quality of care in a more comfortable environment.

'However, we don’t know about the sustainability of these findings in the longer term and organisations wanting to replicate the service in their own area must note that success relies on building and maintaining effective relationships between staff and GPs.'

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