A recent pilot scheme carried out in nursing homes across east London that allows home visits from a specially allocated GP has shown promising results, significantly reducing hospital admissions for the elderly residents and saving the NHS an estimated £1,000 per patient.
Elderly people residing in care homes usually have poorer health and therefore greater needs than those who still live in their own homes. Their access to primary care services is often limited and lacks continuity, leading to escalating health problems and greater hospital admissions than over-75s in the general population.
Usually, care home residents are registered at their local GP practices, which may or may not offer home visits. A review by the Care Quality Commission in 2012 found that only 38% of care homes had regular visits from GPs. This means that most residents either have to travel to see their GPs, which may be difficult for those with mobility problems, or rely on telephone consultations, rather than seeing a doctor in person. A further issue is that, particularly in larger GP practices, the individual GP will often be different at each visit. This can lead to a lack of personal knowledge of that patient’s history, making it more difficult for the GP to provide them with the best care.
The new scheme, ‘Health 1000’, was rolled out in the London boroughs of Barking and Dagenham, Havering and Redbridge across four nursing homes to benefit over 400 elderly people. The homes were chosen on the basis that they had particular difficulties accessing GP care. Each home was allocated an individual GP, directly employed by ’Health 1000’, to provide 12 hours per day, seven days per week support to the residents. The GP was available to visit the home rather than requiring residents to travel. A consultant geriatrician was also provided to give training to care home staff.
The scheme cost in the region of £400,000 and was jointly funded by local commissioning groups and the Prime Minister’s Challenge Fund, a scheme launched in 2013 to improve primary care services.
Patients reported that the increased access to GPs often led to problems being raised and discussed at an earlier stage, meaning that illnesses were less likely to worsen over time and were therefore easier to treat. Care home staff found that having the GPs on hand enabled them to ask questions and, in some circumstances, avoid unnecessary A&E visits for residents. Access to medicine was also improved and delays were avoided.
The Nuffield Trust, an independent health think tank, published a report on 4 April 2018 evaluating the scheme and found that there had been a 38% reduction in admissions to hospital in those care homes, compared with a 4% reduction in comparator homes. In terms of days spent in emergency beds, the reduction was even greater, at 53%, compared with no reduction at all in the comparator homes. The reduction was most notable during the last three months of the patient’s life. The report estimated that the annual saving to the NHS was over £1,000 per patient.
The scheme’s success is a positive step forward for elderly care and it is hoped that it will be applied across the UK over time. For now, the plan is to roll out the scheme across all 39 nursing homes in the London boroughs of Barking and Dagenham, Havering and Redbridge.
Camilla Wonnacott, an associate in the clinical negligence team at Penningtons Manches, who specialises in cases involving elderly care, said: “We often receive enquiries from elderly care home residents or their families when there are concerns about the care provided in their home. This scheme shows how carefully targeted care of the elderly can improve their quality of life whilst also reducing the overall cost to the NHS.”