Pilot scheme reduces visits

MORE than 250 admissions to hospital – at a cost of half a million pounds – have been prevented thanks to a pilot project.

The Total Care pilot scheme was launched two years ago across five practices in the Ipswich area, with the aim of reducing the number of people being admitted to hospital.

Thanks to the scheme, launched by IPSCOM – a GP commissioning consortium in Suffolk – a total of 256 admissions were prevented, at about �1,500-�2,000 each, which equates to �500,000.

Dr Paul Bethell, lead GP of IPSCOM, which covers 15 practices in Ipswich – said the pilot was set up to deliver better systems of care for older people. Older people’s care was targeted as they are the group most likely to be admitted to hospital. The idea of the scheme is an integrated case management approach to assessment and care planning – the ideal being to deliver care at home.

A Total Care team was set up, which consisted of representatives from health, such as GPs, councils, community services and hospitals.


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Dr Bethell said: “We have been working on this pilot to deliver better systems of care for older people. We provide case management for those with long-term conditions and the aim is to improve the care.”

He added that the user feedback had been positive as patients and carers felt it was supportive.

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The project is now set to be rolled out to all of the 15 IPSCOM practices.

One example where the scheme helped was for a woman who had breathing difficulties. The community matron provided her with equipment and training to enable to monitor her own oxygen levels and this made her feel more confident about managing her own condition. As a result it cut down on a number of GP and hospital visits.

The project also led to the introduction of two new consultant interface geriatricians. They work in Ipswich Hospital to identify elderly patients who could be discharged and cared for at home.

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