Let’s work together: when primary care innovation works for the ED (A&E)

In Canterbury and The West Coast, Dr Greg Hamilton, Team Leader of Intelligence and Transformation, explains how their Acute-demand service has helped make their District Health Board (DHB) the lowest in country for Emergency Department (ED) presentations.

The Acute-Demand Service is a high trust approach. It allows GPs to provide services or activities for patients who would otherwise need to go to hospital but could be managed in the community with extra resources (they then bill the DHB for this activity).

Every year the DHB supports approximately 34,000 episodes of Acute-Demand care. This innovative approach has resulted in ED presentation rate in this area being 25% below the national average and acute medical admissions being 30% below by enabling GP teams to manage care closer to home for these patients.

An Acute-Demand intervention may be as simple as arranging medication to be collected for a patient with pneumonia so they can manage their condition at home or a nursing or support staff visiting the patients’ home to make sure there’s food in the fridge.

Dr Greg Hamilton explains that “Having the resource to do that is the way we work”

Dr Hamilton also explains how clinicians in general practice embrace the Acute-Demand model because it provides variety and a break in the 15 minute wall-to-wall consultations which can cause dreariness to set in. It allows GPs to be involved in an aspect of care that is more in-line with old fashioned family practice medicine. The model of the Acute-Demand Service enables GP teams to maintain their skill sets of and for staff to work at a broader scope.

“It allows us to provide the care you wouldn’t do otherwise with a 15 minute consult”.

The Acute-Demand service runs as a high trust model reporting to the DHB the number of care activities they have provided under this arrangement. But with all this high-trust, arms-length monitoring how does the funder and the provider monitor the services? The data Canterbury DHB collect allows the team leads to approach practices for a “peer-to-peer conversation”. I was able to see from the data sets and graphical displays how easy it is for the teams to identify which practices were charging more for which services and, in a very relaxed approach to monitoring, the team leads can point out to the practices that they are above the charging average for that service. Dr Hamilton reports that this feedback tends to bring practices back in line. In fact, through running simulation models this approach appears to be up to four times more cost effective for the DHB than the admissions that would occur otherwise.

Canterbury DHB has an inspiring approach to innovation and care provision and Dr Hamilton’s ending remarks sum up their approach:

It’s become part of the way we operate, it all comes back to trust.

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