7HAS THE PROVISION OF A GP LED LOCAL ENHANCED SERVICE TO A NURSING HOME REDUCED HOSPITAL ADMISSIONS? A COMPLETE AUDIT CYCLE FROM EASTERN CHESHIRE

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Abstract

Evidence base: In recent years, inadequate health care provisions to nursing homes have been reported (British Geriatric Society, June 2011). One potential solution proposed is for GPs to be contracted to provide enhanced services to local nursing homes, aiming to improve areas such as hospital admissions. Early pilots into a weekly, proactive GP visit have shown promising results in this respect (PULSE, September 2011). Such services have recently been introduced in Eastern Cheshire. This audit aimed to demonstrate whether the provision of a GP Local Enhanced Service to a Nursing Home improved admission rates in our area.

Change strategies: The implementation of a fixed, once weekly visit to the local nursing home by the same GP. The rates of hospital admission in one six month period before this intervention and two six month periods after this (2010-12) were compared with an optimal audit standard of 8% of nursing home residents (Yorkshire and Humber NHS, 2010).

Change effects: A significant reduction in the rate of acute admissions to hospital was seen after the GP led visit and the audit standard was almost achieved. The percentage of residents admitted prior to the set visits was 28% in six months. This then reduced to 21% in the first re-audit and 8.8% in a subsequent six month period. This represents 68.6% (p= 0.034, Fisher's exact test) reduction in hospital admissions after GP visits in the last six month audit period compared with the first.

Conclusion: Introduction of one dedicated GP session per week via a contracted Local Enhanced Service to a Nursing Home has shown a statistically significant reduction in admissions to hospital. If this trend can be replicated on a larger scale residents should benefit from having consistent care and avoid potentially distressing hospital stays. Additionally, fiscal and resource benefits should be seen.

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