The GPs who are cutting hospital admissions: Surrey doctors believe they have greatly improved services to patients by setting up a community-based clinic
As GPs take on responsibility for spending the bulk of the NHS budget, doctors in 17 general practices in Surrey have already organised better delivery of care for their patients by bringing secondary services into the community.
The Epsom Downs Integrated Care Services (Edics) consortium was conceived in 2005 when local GPs became increasingly frustrated with the referral process. "There were often reports of missing records, long waiting times, and a general sense of patients having to battle every inch of the way to get what they needed from their local healthcare system," says Dr Peter Stott, one of the founders."With the primary care trust (PCT) facing increasing financial pressure and a new system of hospital payments being introduced [called payment by results], we knew that unless we took some positive action, the situation was only likely to get worse and patient services would continue to suffer."
He adds: "This wasn't because of inadequate capacity in the hospital system or poor clinical skills, it was mainly because of poor integration of services and the lack of a patient-focused system. Patients found clinical services disorganised, intimidating and frustrating to use. This, in turn, led to demoralisation among healthcare professionals, with a haemorrhaging of money as attempts were made to solve ongoing problems."
Local GPs set up Edics two years later as a specialist personal medical services company with the aim of providing all services free of charge on the NHS to a population of 120,000.
Doctors began to send all their referrals to a central "hub", where specially trained local GPs, termed local care physicians, could assess cases and ensure that information on patients was co-ordinated.
"So, instead of waiting for a hospital appointment to address a health problem, some patients can be seen far sooner by a specialist clinician – a consultant – in a community setting," explains Dr Anne Hollings, a local GP who now works as Edics's medical director. "As well as giving the patient speedier treatment and more convenience, without the stress of going to hospital, it also helps to free up local hospital services so they can focus on patients who need hospital care."
Nearly half of patients receive their treatment in the community. This amounts to more than 18,000 visits to a community-based clinic, rather than a secondary-care hospital service. "This has allowed us to make savings of more than £500,000 annually for NHS commissioners, compared with the traditional system," says Hollings.
As a result, patients have the convenience of outpatient appointments in the community clinic, based in the town centre, next to the library and shops, and local hospitals have reduced waiting times.
Stott admits that in the early days the three local hospitals saw Edics as a threat. "They thought we would be taking work away from them, but fairly soon they realised that diverting some services to Edics could actually help them to focus on their core services – for patients who need to go to hospital. And compared with their turnover of something like £200m a year, ours is in the region of £2m, so we're not taking huge chunks of their work."
One local GP says: "Sadly, before Edics, patients could often find themselves 'bounced around' different services for many months before they reached the right person to fully address their clinical needs. In my experience, this often meant referring the same case on several times, with patients returning to complain that they were not getting what they needed – an environment no GP wants to operate in."
On a visit to the Edics clinic, patients seem very satisfied with the service. Bob O'Donoghue, a 53-year-old diabetes patient, says: "I used to go for my outpatient appointments at the hospital and often there was a long wait and it was very impersonal, but here you're seen on time, the staff are friendly and it's right in the town centre." Another patient, Doreen Tickner, in her 60s, says: "They give you a very good service here – the nurses know who you are and it's a very relaxed atmosphere with the doctor."
Edics recently won a contract as an "any qualified provider" (AQP) to deliver secondary care services. AQP status was introduced under the last Labour government in order to open up the NHS to a plurality of private and not-for-profit healthcare providers.
With the setting up of clinical commissioning groups (CCGs) to commission the bulk of NHS services for patients, there are concerns about conflicts of interest between local GPs who are on their CCG but are also directors or shareholders in private companies that will be competing to win business from the CCG. A study last week found that one in three GPs in CCGS are linked to private firms.
According to Edics, none of their directors are on the local CCG.
Karen Parsons, chief operating officer at Surrey Downs clinical commissioning group, says: "We take our responsibilities for managing conflicts of interests extremely seriously, and where members of the CCG have other interests these are fully declared and carefully managed in line with our own robust policies."
She adds: "Edics provides a range of community-based clinics and other services for local patients. This means patients can be treated closer to home, which is very much part of our vision."
Edics appears to be the direction of travel for the new GP-led NHS, so it is no surprise that Stott says other GP consortiums from around the country have been beating a path to its door. "They like what they've seen," he says. The Guardian
As GPs take on responsibility for spending the bulk of the NHS budget, doctors in 17 general practices in Surrey have already organised better delivery of care for their patients by bringing secondary services into the community.
The Epsom Downs Integrated Care Services (Edics) consortium was conceived in 2005 when local GPs became increasingly frustrated with the referral process. "There were often reports of missing records, long waiting times, and a general sense of patients having to battle every inch of the way to get what they needed from their local healthcare system," says Dr Peter Stott, one of the founders."With the primary care trust (PCT) facing increasing financial pressure and a new system of hospital payments being introduced [called payment by results], we knew that unless we took some positive action, the situation was only likely to get worse and patient services would continue to suffer."
He adds: "This wasn't because of inadequate capacity in the hospital system or poor clinical skills, it was mainly because of poor integration of services and the lack of a patient-focused system. Patients found clinical services disorganised, intimidating and frustrating to use. This, in turn, led to demoralisation among healthcare professionals, with a haemorrhaging of money as attempts were made to solve ongoing problems."
Local GPs set up Edics two years later as a specialist personal medical services company with the aim of providing all services free of charge on the NHS to a population of 120,000.
Doctors began to send all their referrals to a central "hub", where specially trained local GPs, termed local care physicians, could assess cases and ensure that information on patients was co-ordinated.
"So, instead of waiting for a hospital appointment to address a health problem, some patients can be seen far sooner by a specialist clinician – a consultant – in a community setting," explains Dr Anne Hollings, a local GP who now works as Edics's medical director. "As well as giving the patient speedier treatment and more convenience, without the stress of going to hospital, it also helps to free up local hospital services so they can focus on patients who need hospital care."
Nearly half of patients receive their treatment in the community. This amounts to more than 18,000 visits to a community-based clinic, rather than a secondary-care hospital service. "This has allowed us to make savings of more than £500,000 annually for NHS commissioners, compared with the traditional system," says Hollings.
As a result, patients have the convenience of outpatient appointments in the community clinic, based in the town centre, next to the library and shops, and local hospitals have reduced waiting times.
Stott admits that in the early days the three local hospitals saw Edics as a threat. "They thought we would be taking work away from them, but fairly soon they realised that diverting some services to Edics could actually help them to focus on their core services – for patients who need to go to hospital. And compared with their turnover of something like £200m a year, ours is in the region of £2m, so we're not taking huge chunks of their work."
One local GP says: "Sadly, before Edics, patients could often find themselves 'bounced around' different services for many months before they reached the right person to fully address their clinical needs. In my experience, this often meant referring the same case on several times, with patients returning to complain that they were not getting what they needed – an environment no GP wants to operate in."
On a visit to the Edics clinic, patients seem very satisfied with the service. Bob O'Donoghue, a 53-year-old diabetes patient, says: "I used to go for my outpatient appointments at the hospital and often there was a long wait and it was very impersonal, but here you're seen on time, the staff are friendly and it's right in the town centre." Another patient, Doreen Tickner, in her 60s, says: "They give you a very good service here – the nurses know who you are and it's a very relaxed atmosphere with the doctor."
Edics recently won a contract as an "any qualified provider" (AQP) to deliver secondary care services. AQP status was introduced under the last Labour government in order to open up the NHS to a plurality of private and not-for-profit healthcare providers.
With the setting up of clinical commissioning groups (CCGs) to commission the bulk of NHS services for patients, there are concerns about conflicts of interest between local GPs who are on their CCG but are also directors or shareholders in private companies that will be competing to win business from the CCG. A study last week found that one in three GPs in CCGS are linked to private firms.
According to Edics, none of their directors are on the local CCG.
Karen Parsons, chief operating officer at Surrey Downs clinical commissioning group, says: "We take our responsibilities for managing conflicts of interests extremely seriously, and where members of the CCG have other interests these are fully declared and carefully managed in line with our own robust policies."
She adds: "Edics provides a range of community-based clinics and other services for local patients. This means patients can be treated closer to home, which is very much part of our vision."
Edics appears to be the direction of travel for the new GP-led NHS, so it is no surprise that Stott says other GP consortiums from around the country have been beating a path to its door. "They like what they've seen," he says. The Guardian
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