Dedicated GP support for nursing homes sees significant drop in emergency admissions

A new GP service offering seven-day-a-week support to four nursing homes has resulted in a 36% reduction in emergency admissions to hospital, with the largest reductions happening during the last three months of a person’s life, a comprehensive study by the Nuffield Trust shows. [1]

The evaluation of the new service, piloted in the Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups (CCGs), also found emergency bed days spent in hospital fell by 53% and the scheme provided a better quality of care for residents.

The scheme, called Health 1000, offers nursing homes access to 8am–8pm seven-day-a-week GP support as well as training and advice for care home workers and help from a geriatrician.

Using anonymised data, the Nuffield Trust looked at how residents in the Health 1000 nursing homes used hospital care compared to residents from nursing homes not using the service.

Key findings from the evaluation include:

• After registering with the Health 1000 service, emergency inpatient admissions fell by 36% compared to 4% reductions in the comparator group.
• The authors estimate that the monetary value of reductions in emergency admissions could be as much as £1000 per person per year, but that this is not necessarily directly equivalent to actual cash savings for either commissioners or providers.
• Emergency bed days in the Health 1000 group reduced by 53% compared to no change in the comparator group.
• The biggest reductions in emergency admissions and bed days happened towards the end of people’s lives.

Previously, lack of timely advice from a medical professional with good knowledge of the homes meant staff working in the nursing homes felt risk averse and therefore more likely to send a resident to A&E, the study found. When interviewed by the report authors, staff said that they now felt more supported and confident as a result of the new service, thanks to having quick access to advice over the phone from a GP they know and in person during their regular weekly visits.

The success of the new primary care service in care homes in general, the report authors suggest, depends on the quality and continuity of relationships developed between the GPs and the care homes.

Commenting on the report findings, 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.”