Can technology cut NHS costs?

GP consortia have leapt at the chance to pilot hi-tech clinical dashboards. Stephen Robinson reports.

The DoH aims to embed clinical dashboards developed in an NHS Bolton pilot in all GP consortia and practices by 2013 (Photograph: DoH)
The DoH aims to embed clinical dashboards developed in an NHS Bolton pilot in all GP consortia and practices by 2013 (Photograph: DoH)

Demand from pathfinder GP consortia to pioneer a novel software tool designed to cut urgent care admissions has outstripped a DoH target four-fold.

The deadline for applying to pilot the tool closed last month. The DoH will now select 10 GP consortia and PCTs to develop 'clinical dashboards' so GPs can track local urgent care activity.

It will form part of the DoH's Quality, Innovation, Productivity and Prevention (QIPP) programme, which aims to cut urgent care admissions by 10 per cent by 2015.

GP understands 40 consortia and PCTs have now volunteered to develop a dashboard system for their practices.

Derbyshire GP Sir John Oldham, national clinical lead for quality and productivity, will oversee the project: 'In all the years I've been in this work-stream, we've never had something so enthusiastically received as this,' he says.

Urgent care activity
The scheme began in 2008 when NHS Bolton developed a clinical dashboard for general practice. This gave GPs a clearer picture of patients' urgent care activity, so they could ensure patients accessed the appropriate services.

The PCT piloted its dashboard in 2009/10 in 56 practices. That year, A&E admissions in the area fell 3 per cent amid a regional increase of 9 per cent.

Unscheduled hospital admissions fell 4 per cent, while one practice saw reductions of 16 per cent. The pilot's success spurred the DoH to move to a larger nationwide scheme.

The decision is timely. Last year, a Nuffield Trust report warned that cutting England's 'unsustainable' rise in A&E visits should be the number one priority in the NHS or it will become 'unaffordable'. It found A&E admissions rose to five million by 2008/9, costing the NHS £11 billion a year.

Bolton GP Dr Anne Talbot, national clinical lead for the Urgent Care Clinical Dashboard, helped develop Bolton's dashboard project and says it will be 'invaluable' for GP commissioners.

'The data that we use has always been accessible to GPs,' she says. 'However, it is now integrated in "real time" and is easily viewed in one place: on the GP's desktop. That's the key.

You can identify patients that may be struggling and, as a result, GPs are able to be more proactive.'

The dashboard allows GPs to track individual patients who may be accessing urgent care frequently. Dr Talbot says: 'We're often not aware how often those people are accessing urgent care.

The dashboard allows GPs to track individual patients who frequently access urgent care



Under the radar
'For example, an elderly gentleman had been to a walk-in centre to get an inhaler prescription twice in recent weeks. We invited him in and found he had signs of early dementia and was struggling.

'He's someone we wouldn't normally pick up. This tool helps us to identify patients who are under the clinical radar,' she adds.

Furthermore, Dr Talbot believes the system can be used to track disease outbreaks in the community. 'I use it myself to look at trends - for example, during the flu outbreak, we saw trends in usage of out-of-hours services,' she says.

There will be no standard NHS dashboard for primary care. Rather, the 10 sites chosen by the DoH for the pioneer stage will develop their own dashboards based on local requirements, using NHS Bolton's version as a guide.

If it is a success, the DoH aims to embed dashboards in all GP consortia and practices by 2013. Sir John is confident that if this happens, the system can contribute to the 10 per cent QIPP target.

But Dr Talbot warns dashboards should not be used by the department, or any primary care organisation, to monitor individual practice achievement. 'I do think we have to be very careful about using it as a performance management tool,' she says.

'It's a tool for care. There are lots of other ways to performance manage.'

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