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Admissions reduced by hospital GPs

GPs in a special hospital unit help find community-based care where possible, says Dr Rebecca Chowdhury

The Acute GP Service (AGPS) in Plymouth is a unique primary care service based at the acute medical assessment unit at Derriford Hospital.

The service, which currently runs four days a week between 9am and 5pm, was developed to improve care pathways for patients at the point of GP referral for medical admission.

The GPs working for AGPS, myself included, take calls from their peers — GPs making referrals. Admission is never refused, but by discussing the referral, we can offer alternative, optional services.

AGPS launched in August 2005 and an audit of activity on the days on which it was running between 4 October 2005 and 30 September 2006 revealed that AGPS has reduced medical admissions via GP referral by a third (see box).

Since then we have continued to deliver high-standard patient-centred care, our staffing levels have increased and the hospital is making significant savings.

The service is funded through savings made by avoided admissions where selected patients are diverted to outside the hospital setting.

All clinicians working for AGPS are experienced GPs who practise locally. I joined Dr Peter Rudge, the clinical lead for AGPS and Dr Ben Jameson in May 2006.

There are now five GPs working for service and we are looking to recruit more in the future.

Needs assessment
As well as direct calls, the service links with the emergency physicians and has produced a compendium of available alternatives to admissions.

In the mornings, the service has links to the acute physician ward round and works with the discharge team to facilitate early discharge by identifying patients who could be cared for in primary care. A small team of redirected staff also supports the GP on duty.

When the trust receives a GP-initiated medical admission referral one of the service’s GPs is available on ‘the referral phone. This allows any referring GP who wishes to send a patient to the acute medical assessment unit to have a peer case discussion.

This enables the patient’s (and the GP’s) needs to be identified from the outset.

If it is agreed that there might be an opportunity to avoid admission via appropriate advice/investigations or intermediate care, an AGPS doctor will normally see the patient. We can discuss the case with consultant specialists to plan alternative routes for the patient, such as urgent outpatient assessment by them.

Rapid response support
AGPS has a named transport co-ordinator: a healthcare assistant working on the acute medical assessment unit who will arrange ambulance transport and also inform the AGPS GP on-duty when the patient arrives.

We aim to assess the patient within a short time of their arrival. We share decisions with the patient and aim to give them fully informed choices on their treatment.

Another priority is to have any investigations required done rapidly although this occasionally means treating selected patients as outpatients over several days.

Our service is supported by a rapid response team that facilitates safe and timely discharge of medically stable but vulnerable patients into their homes or to intermediate facilities, community hospitals and care homes. We help the team identify patients who have social issues. We aim to communicate with the referring GP the same day, via a typed, faxed (then posted) letter.

I was attracted to the job because I saw a great opportunity to develop a portfolio career that included my ongoing experience and interests — particularly in care of the elderly and care in the emergency setting — while being part of something unique. AGPS has opened my eyes to the grey interface between primary and secondary care.

Being hospital-based also empowers me to facilitate care pathways on behalf of my GP colleagues referring patients and improve communication.

This is an incredibly exciting project to work on. We are continuing to develop closer working relationships between GPs and consultants and we are here to stay.

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