How to reduce unscheduled admissions in the over-75s by 20%

A Sheffield practice enjoyed award-winning results with its targeted strategy to improve healthcare quality in its elderly population. Neil Durham reports

Dr Steve Thomas (fifth from left): 'This approach has resulted in a 20% reduction in unscheduled admissions in over 75s.'

The Dykes Hall and Deer Park Medical Centres in Sheffield won the improving quality and productivity section of the GP Enterprise Awards 2012, earning it £1,000.

Dr Steve Thomas, who entered the team in the awards, explains that the prize money will be used to start an equipment fund and that the practices’ patient participation group will be consulted.

Sheffield CCG has asked the city’s university to evaluate the effectiveness of the practices’ multi-disciplinary team-approach and whether it can be improved.

The problem

Across the NHS GPs are being asked to offer better care with increasing financial and capacity pressures. They are focusing on changing the way they work to deliver more effective services.

Dr Thomas’s practices are two of 16 located in the west of Sheffield. Locally 7.4% of the population is aged 75 or over. In 2008/9 £106 million was spent on emergency admissions with a quarter being made up of over 75s. A quarter of unscheduled admissions are thought to be avoidable with exacerbation of long-term conditions expected to be a good area to target.

The solution

 The EARLI/PARR (Emergency Admission Risk Likelihood Index/Patient at Risk of Re-hospitalisation) system was used to identify at-risk over-75s. Small numbers of identified patients were allocated to GP partners to perform a notes review prior to an initial meeting. Patients were assessed to see whether they were allocated to an appropriate health professional and if there was a falls risk. Meetings were used to discuss patients and whether they had moved up or down the care ladder. For example, some may have initially been allocated to the community matron but thanks to interventions been moved back to practice care with the practice nurse supervising long-term conditions.

Many over-75s were also on or potential candidates for the end-of-life/palliative care list and so a nurse specialist was also invited to meetings.

The results

Dr Thomas says: ‘This approach appears to have resulted in a 20% reduction in unscheduled admissions in the over 75 age group for our practice, resulting in savings of £101,249.

‘This is compared to a reduction of 7.7% for the city of Sheffield as a whole and many other practices having significant increases.

‘The multi-disciplinary team approach has engendered excellent team working relationships, which has extended to consultant colleagues joining.

‘We were asked by our CCG locality group to share this approach and this has resulted in three educational events that has disseminated our learning.’

The future

Dr Thomas sits in the meeting room in the floor below reception at Dykes Hall Medical Centre, introduces and congratulates his team.

It includes Vincent Clubb, a consultant community geriatrician from Sheffield Teaching Hospitals Trust, and Dr Thomas admits that with 88 practices in the city such specialist involvement at practice-level is unlikely to be practical everywhere. However, the city is looking at forming GP associations, similar to the RCGP’s federation model, and it may be that this approach could work at that population level. There is a willingness from secondary care to explore such integrated care team issues.

Gesturing about the room, Dr Thomas says: ‘Using the extensive knowledge around this table has made a great difference.’ He mentions the input of district nurses and the administrative staff’s excellent note-keeping skills which keep everyone accurately informed.

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