AT A GLANCE
THE CHALLENGE
East Warrington PCN had a higher than average percentage of high intensity users (HIUs) – patients who had attended the emergency department (ED) five or more times in 12 months.
The 144 patients, representing 0.4% of those registered with the PCN, accounted for 14% of ED attendances and 20% of unplanned hospital admissions. They had much higher levels of comorbidities than other patient groups and seven GP appointments on average compared with three for other patients. They were taking 29 distinct medications compared with seven for the general patient population.
WHAT WE DID
The CLEAR national team met the Integrated Care System HIU lead who takes an MDT approach for all ED referrals involving partner agencies. They interviewed key staff across the Cheshire and Merseyside Integrated Care System. Patients with more than five ED attendances between August 2020 – July 2021 were identified from PCN data and compared with all 20,000 patients needing care in the same period.
CLEAR RECOMMENDATIONS
It was recognised that East Warrington PCN had already made good progress with integrated working with key strategic partners and a good MDT model for HIUs already existed in secondary care but there needed to be closer working between the service and the network.
The project team recommended that a primary care HIU lead should be appointed to support patients and a central hub created with easy access to clinical staff, with referrals from both the PCN and the acute trust. MDT meetings should be increased to weekly rather than monthly, an out-of-hours team for HIUs considered and access to health and social care teams improved.
The new model of care would have a dedicated team including advanced practitioners, care coordinators and health and social wellbeing coaches. Working with the secondary care team, they would proactively care for patients providing a range of services including regular medication reviews, psychological therapy and support with benefits, exercise and housing.
FORECAST IMPACT
Holistic, proactive and co-ordinated care for HIUs would help to address health inequalities, improve access to community-based support and the wellbeing of patients.
The new measures would lead to significant reduction in GP appointments, ED attendances and hospital admissions for HIUs which cost £520,390 between August 2020 to July 2021.
The new model of care would involve estimated annual workforce costs of £73,442. There would be forecast annual productivity savings of £122,466 from a 25% reduction in GP appointments and a 40% reduction in ED attendances and emergency hospital admissions.
