UPTON SURGERY RISK STRATIFICATION PILOT May 2014 Progress Update

The Business Case The Kings fund paper has identified that the number of elderly patients living with 3 or more long term conditions will increase by over a million patients by 2018. At Upton Surgery this trend is already pressurising the traditional 10 minute appointment system. Aim to develop (and cost) a model to accommodate patients with multiple pathology.

The Business Case Using the ACS risk stratification tool to identify those who most would benefit, we piloted ‘intensive primary care review model’. GP time to select patients from ACS risk strat data scores 0.5 and above and local knowledge. 30 minute appointments.

Business Case COHORT ONE: 76 ambulatory patients with three or more long term conditions COHORT TWO: 25 housebound patients with three or more long term conditions

What we did GP preparation time to review notes and prioritise patient selection process, contact patients and undertake pretest requirements prior to intensive consultation. Pharmacist review and recommendations Allow one hour for home visit, 30 minute appointments for ambulatory cohort Follow up GP time

Patient feedback Pre and post evaluation but a bit hit and miss!! 15 pre and post returned 12 pre only completed 15 post only returned ? Did GP give the pre one out? Conclusion we need a better process for this!

Patient comments ‘Very helpful, I felt that in time of need there was someone out there to turn to thank you’ ‘Having more time to discuss the number of medical issues I have was a big help’ Early findings we noted on the question ‘understanding of why you were taking different medications’ there was a favourable shift of 16 points in the scores also in the ones that only did a pre there were scores of 1 and 2 in the ones that only did a post all were above 7.

Clinician comments ‘It allows GPs to prioritise and practice proper medicine’ ‘It allowed you to get to grips with the patients care so often you are fire fighting. It allowed you to do some proactive rather than just reactive medicine’ ‘Need to see the audit of risks and ? Admissions prevented and outcome data’ Some patients didn’t seem to understand the idea even with an explanation

Which brings us to evaluation that is underway now. We seriously underestimated (and under costed) the admin time to undertake this as an ongoing exercise. Dr Phil Thompson about to start helping us. The time in lost regular appointment slots when access is key but demand grows exponentially. The cost in back fill locums to make up the above this is not a cheap model but if it saves admissions would prove cost effective.