Dr John Havard: Mission Impossible - or is it?

The A-Team always had a masterplan...

The A-Team always had a masterplan... - Credit: Archant

Many seasoned readers will remember the original TV series that went out in the ‘60s and ‘70s when there were only three channels available.

Every week ‘Jim’ would decide to accept an impossible mission seconds before the cassette player self-destructed in a plume of smoke. I was reminded of this when the NHS issued the £5 per patient payment for achieving a 15% reduction in hospital admissions via A&E.

Since these admissions have been rising year-on-year since they started building hospitals, the task for GPs certainly looks impossible enough. Half the money was due to be issued locally on the production of a credible plan and the other half after success had been achieved.

Since all the brains and cash the NHS could formerly muster have made no impact, I expected the GPs to take the £2.50 per patient first payment and do what the NHS managers have done before – write a plan and watch it fail.

However, despite recent cuts, I really believe your local GPs are resourceful enough to implement some changes across east Suffolk that could really tackle the crisis. Any success would surely be the bedrock for increased investment in the future.

What is the Masterplan?

We need a plan to work across the east Suffolk community and it needs the support of GPs, Ipswich Hospital, social care, voluntary organisations and most of all, the patients. Many hands make light work and a systematic plan could just hit the spot.

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What facts underpin the plan?

We know several statistics that might surprise you:

n 80% of ambulances that arrive with patients over 75 result in admissions.

n 20% of our over 75s are admitted to hospital each year. Many of these are because people live alone and need support to get over short term illnesses that make it unsafe to be at home alone.

n Nationally 6% of patients admitted to hospital pick up an infection while there.

What can be done across east Suffolk?

n Provision of comprehensive patient notes on those likely to deteriorate. Plans from the usual GP for handling predictable changes in condition that have been agreed with the patient.

n Expansion of yellow folders in the house in which patients have expressed their wishes on their future care when they were well and able to make a choice supported by family and carers.

And something more radical

Instantcare is set for a come back in which a trained carer moves into an elderly person’s home for up to 72 hours to provide care and ensure food, drink and medication are taken. As qualified carers they can deal with the personal care needed to restore the patient to health. 30% of Ipswich Hospital admissions are for less than 24 hours so surely we can make an impact while improving a patient’s care by giving them one-to-one help?

A&E triage could also make a difference. If every patient arriving at A&E is screened by a GP first then more patients will end up being managed in the community. Make no mistake this plan would be quite different to A&E staff deciding which patients could see a GP which is predicated on the status quo. If the NHS is to survive then the only tenet that should be upheld is to provide the best care in the best location – certainly not the default position of an A&E admission.

Moving forward to TV drama of the ‘80s I would like to employ Mr T (from the A Team) on the A&E reception desk to help sort out who really needs emergency treatment and who could be looked after closer to home.

Accident and emergency receptionist – are you sure you are in the right place?

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