One of the ways McKinsey has decided it's possible to save £20 billion in the NHS is to reduce the number of acute admissions made to hospitals.
Acute admissions are, of course, the emergency ones, that go through accident and emergency or straight into a medical assessment unit.
I am now aware that some Primary Care Trusts are asking GPs to reduce the number of these admissions by 20%. This is a curious target. Only 25% of acute admissions are referred into hospital by GPs. The rest of these admissions, all of whom are by definition GP patients and are therefore logged against their names, turn up in hospitals inthe back of ambulances, or are driven there by their friends or relatives when seriously ill.
To deliver the reduction in acute admissions demanded of GPs they either have to stop their referral of people who front up with heart attacks in their surgeries by 80%, or they have to ignore meningitis in children, or send people home with deep vein thromboses. Alternatively, they have to set up roadblocks that prevent ambulances carrying their patients arriving at accident and emergency units.
None of these are very likely, are they?
I wonder how much McKinsey's were paid for this fabulous insight? And I wonder what part of the savings will result from this cut in admissions? I suspect it will be close to 0%.
This is because GPs refer people to hospitals because they are sick, not because it is fun. And they do so because they know that if they get things wrong they are likely to suffer serious consequences, including being sued, and being referred to the General Medical Council. All of those complaints procedures will, of course, remain intact despite the cuts. But supposedly McKinsey think that GPs will now take a massive increase in risk to help balance the books of the NHS.
I have a message for McKinsey and Andrew Lansley: they may be stupid, but GPs aren't, and the rest of us should be grateful that GPs will still refer when necessary.
Disclosure: I am married to a GP
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I think this is a blunt target and unachievable in the short run but as a goal it is a reasonable one. However meeting that goal will cost money in the short and medium term. One concern in primary care at the moment is the number of people who get admitted inappropriately. These are mostly people with life-long chronic illnesses who suffer an incident and get rushed into hospital. Better pro-active care can enable them to stay at home more frequently. That however requires investment in primary care services which means either reducing secondary care budgets or an overall increase in funding. Neither is going to happen. That is a crying shame because reducing unplanned, emergency admissions through better services for care in the community is good for everyone.
And who will provide this care at home?
It will need a massive investment
It wouyld be better in many cases than hospital care – but right now a massive shortage of GOPs is looming – no one wants to do it, for good reason
You really don’t know what you are talking about.
“Acute” admissions means any admissions to hospitals. The NHS plans that in future a substantial portion of the admissions to hospital will be reduced, either because improved technology means that the need for surgery is reduced, or because polyclinics and the like will treat “urgent” cases that do not require hospital admission or because the need for admissions is better managed. One of the most common causes of hospital admissions is falls by elderly people who on average call up the out of hours service and are whisked straight into hospital, where in reality most of them could be seen by an on-call GP in their home and only referred to hospital when required.
No, with respect that’s completely wrong.
Acute means serious, requiring urgent attention
And yes, some of those are the old who fall over in the night and who are seen by a GP – and out of hours GP – who sends them in because they need X rays and immediate care – usually with regard to mobility and there is no one to provide it
So your answer is ill informed and wrong
Where ever the patients get treated, in hospital or in the community the saving will be off set against the new provision. It shifts rather than removes the cost, whilst some admissions are unnecessary most are as stated previously, needed for bloods, X-rays or frequently a bit of space inorder to fully assess the change in a patients condition. Whilst some saving may be able to be made in reducing acute admissions I do not believe it will yield anything like the figures mentioned.
Acute admissions can be elective or non- elective.Non-electives are emergencies plus maternity. Electives are for operations that are planned in advance.
There is much work being done around the country at the moment to identify procedures of low clinical value for which patients may be referred. These are procedures,which, in theory, offer poor clinical outcomes for the money spent ( examples include varicose veins, hernias tonsils etc)
Savings in these areas are forecast as GPs limit referrals.
Non electives can be influenced by improved primary care for ambulatory conditions. There is more but you get the drift?
KP
Sure I get the drift
But that’s not how GPs see this, at all – precisely because as I note, 75% of these admissions are not under their control
And improved primary care is fine – who is going to fund it. GPs are at physical limits now. What’s your suggestion on how they all add a ward round in the community to their existing 11 hours day?
As a practice manager put this objective to me – setting an objective for people who can’t achieve it is an invitation to be ignored, universally. And that is what will happen. So the referrals will carry on. If GPs are penalised they’ll quit – 30% are near retirement age and there aren’t new ones rushing in.
This goes to the core of the NHS
Pretending otherwise is just a game – and a foolhardy one
I don’t often comment or read the comments on this blog though I always read the blog on my feed reader. I find this an interesting discussion. As someone who has started doing research into primary care for very ill people one of the biggest bug-bears I hear from GPs is the frustration over hospital admissions that could have been prevented. On the flip side, there’s frustration that there’s not enough hours in the day for them to do this. Where I agree with you wholeheartedly is that the NHS reforms as stated aren’t going to do anything to help this so lack of reduction of admissions will be used as yet another stick to beat GPs over the head with.
That said, it seems clear that we do need to find better ways of organising care in the community and, if we do, the main prize for patients and families will be reduced admissions. That will benefit everyone, including the NHS as an organisation. However finding the resources and will to do this is exactly the type of central initiative that invests a lot in order to make improvements later that the reforms are going directly against.
There are lots of problems with care in the community. Of course it can work, but if it is simply a matter of piling people into old people’s homes and asking GPs to them look after them when they were previously cared for on a ward there is a massive problem inherent in that: the GPs aren’t funded to cover this, but have to spend a lot of time in those locations, away from patients who need the services that they are used to receiving.
GPs get battered both ways in this case.
Maybe that is the government’s intention.
And you are right, of course there are some admissions which can be avoided, usually because the care system is able to look after somebody outside a hospital. For example, my local PCT has no emergency care for somebody who is immobile. Therefore just because they are temporarily immobile they have to be admitted to hospital, which is quite illogical. That is however the result of cuts.
Privatisation will not solve this. This requires an integrated service with all parts working together, not in competition. There is no prospect of cutting admissions if the direction of NHS reforms in the way that the government wants.
Funnily enough (peculiar not ha-ha) one of the reasons for admission, in chronically ill patients with respiratory illness, is a change in their drug regime which precedes a change in their condition.
Some of the drugs used are expensive and for some reason they get un-prescribed and replaced with others which do not work as well.
A situation which is likely to get worse when cost if drugs becomes more “important”
Personal interest here….I changed my gp for the above reason…since he could give me no valid reason for the change…and the hospital specialists told me the problem was caused by the change.
Agreed – people may have chronic conditions – it does not mean they don’t need hospital care as a result
But you were right re the GP – they have a duty to explain – but can you see the same one twice anyway. Continuity is key to care but is no longer funded
“Chronic” conditions generally don’t need hospital care. The term comes from the Greek “chronos” – time. In other words these are long term conditions: respiratory diseases, diabetes, as well as heart conditions, which are largely treated in primary care, not through admissions in to secondary care (“acute”).
I well understand the difference between chronic and acute. The point however is that when a very significant number of people have chronic conditions, and when the pharmaceutical industry is desperate to increase that number, then the likelihood that those chronic conditions will give rise to reasons for admission to hospital is high.
To pretend that respiratory diseases do not result in admissions, that diabetes never results in hospital treatment or heart conditions can all be treated at home is ludicrous. People with these conditions can be managed, and are managed in primary care but the simple fact is that those with chronic conditions quickly flip over into being in acute conditions, because they are susceptible to them.
GPs know that, and so refer these people, as do ambulance crews, and the families of those who care for those with chronic conditions, quite rightly, because otherwise those people might become very seriously ill, or die, and need hospital care to prevent that happening. If you, of course, are indifferent to that consequence, so be it. I suspect that very many healthcare providers from the private sector will be, and will do their utmost to make sure that these people do not receive the care that they need. Those of us with some compassion think otherwise.
Rising numbers of parents are bypassing GPs and taking children to hospitals’ A&E departments for medical treatment, researchers say.
Attendance for 10 common medical problems, including fever and rash, rose 42% in a decade at Nottingham’s Queen’s Medical Centre, they said.
Difficulty accessing out-of-hours GP care may be to blame, they say in the Emergency Medicine Journal.
The government said it was developing a strategy for out-of-hours care.
It said it wanted to deliver high quality, urgent care services around the clock.
During the past 10 years, the way the NHS provides care for common medical problems at night and at weekends has changed.
http://www.bbc.co.uk/news/health-13500502
As the story, says, a lot of these hospital visits have happened because GPs no longer provide an out-of-hours service.
This may come as a real shock to you, but GPs are human beings.
They are made of flesh and blood. They need to sleep. If they don’t, they make serious mistakes. They have families, children, lives beyond work.
To the great surprise of most people in the population, they can even be ill, suffer stress, depression, and exhaustion. When those things happen people’s lives are put at risk. Despite this you would like them to work 168 hours a week.
That is, of course, completely absurd. But then, so is your entire logic, based upon neoliberalism, with a complete disregard for every aspect of the human condition built into it. Which is the reason why I will not be letting you continue this debate, or any other, because you quite clearly a troll with intent to waste my time.
Round here the GPs don’t have to work 24 hours a day, but their practices still provide 24 hour cover. The GP practice contracts with an outside firm to provide mobile out of hours cover, and the firm drives NHS GP’s to paitients’ homes for urgent care. The patient doesn’t necessarily get to see their normal GP, but they wouldn’t see them if they went to hospital either.
http://www.harmoni.co.uk/site/Harmoni/news-folder/exciting-out-of-hours-opportunities-for-gps-across-the-country?
They claim that it reduces hospital admissions substantially.
By definition having an out of hours service reduces admissions
All areas run out of hours services, of course
But that’s a given: the demand is for a reduction despite this