AT A GLANCE
THE CHALLENGE
Central Camden PCN’s high intensity users (HIUs) – patients who had attended the ED more than five times in 12 months – accounted for 15.4% of all ED attendances in one year and 10.5% of all emergency admissions.
They represented 0.1% of registered patients but created eight times the amount of activity for the PCN’s nine GP practices. These patients had more than 20 times the median number of GP appointments, and three times the number of comorbidities than the general patient population. The estimated annual cost of GP appointments in a four-year period from September 2017 was more than £1 million.
WHAT WE DID
PCN staff were keen to understand how ED attendance by HIUs compared with their use of GP services. Four years of data, from September 2017, was extracted and analysed, comparing HIUs who attended ED and those who had more than two GP appointments per month with information on how the wider population used both services. This analysis revealed that 147 were HIUs. The CLEAR national faculty also compared HIU activity with four other PCNs involved in CLEAR transformation projects.
CLEAR RECOMMENDATIONS
A new HIU service was recommended consisting of care coordinators, advanced practitioners, health and wellbeing coaches and social prescribers – to provide 19 hours of care per patient per year.
The HIU team would signpost patients to other services, provide health promotion advice and practical help with non-medical issues including budgeting, housing and benefits.
Personalised care plans would be put in place for patients with complex needs with early interventions – such as managing breathlessness and coping in the cold weather – for those identified as being at risk of reaching crisis point.
A bespoke matrix developed in partnership with Hyde PCN was used to aid the development of the new model of care to explore the skills and roles needed and quantify them in terms of the number of hours required to deliver each element of care.
FORECAST IMPACT
The provision of proactive, holistic and coordinated care would improve the health and wellbeing of HIUs and ease pressure on both primary and secondary care services.
A potential annual saving of £187,226 could be achieved by a 20% reduction in GP appointments, 40% reduction in ED attendances and 40% reduction in emergency hospital admissions. The annual workforce cost of the new service is estimated to be £46,774, resulting in overall productivity savings of £140,452.
All four new staff roles fall within the Additional Roles Reimbursement Scheme so these costs could be partially refunded.
