Doctor First: Reducing A&E admissions by saving costs in general practice
One of the greatest challenges facing the NHS is the inexorable rise in emergency admissions. They are already the largest proportion of acute care spend, itself the largest element of the NHS budget. The largest proportion of emergency admissions is from self referrals via A&E. This is the fastest growing element of admissions, driven largely by patients over 75, who now represent over 50% of all inpatient days, a number which has grown 66% in ten years, well above the demographic trend and therefore indicating a systemic failure.
This paper analyses attendance and admission data by 604 GP practices in the East Midlands, showing a variation in the age specific rate of one to five. Why is the variation so great? A number of independent variables are tested, but one stands out, an operational factor which could be transferred to any practice.
The details of a system known as “Doctor First” are described, and its benefits for patients are demonstrated. This system applied across all English practices could save around £1bn in practice costs, and a further £1bn in secondary care costs. Patients aged 75+ in the lead practice for “Doctor First” are the least likely in the region to visit A&E, because they know they can speak to their GP within minutes.
http://www.emqo.eastmidlands.nhs.uk/welcome/quality-indicators/care-pathways/primary-care/
