Closer integration with GP practices can reduce unplanned hospital admissions, study shows

Vertical integration, where GP practices join up with hospital trusts, could save the NHS a significant sum every year by reducing urgent care admissions, according to a new study.

Analysis carried out by the Strategy Unit revealed that the Royal Wolverhampton NHS Trust’s integration project with 10 local GP practices reduced the number of unplanned admissions by 13%, generating cost savings to the NHS in the region of £1.7m per year.

Unplanned admissions and readmissions occur when patients are admitted to hospital in an emergency, either via A&E, GP surgeries or other clinics. They are distressing for patients and their families, costly for hospitals, and create uncertainty for those responsible for planning and delivering services. Despite considerable efforts to address them, the UK rate continues to rise year-on-year.

The Strategy Unit, an independent group of expert NHS analysts that aims to improve outcomes, was asked to evaluate the Trust’s vertical integration programme which started in June 2016. The Trust took over staffing, contracts, finance and payroll functions from the 10 GP practices, which were together responsible for the care of just over 67,400 patients. The integration project used a shared management information system and live patient data to track patients as they moved from primary care to community and hospital services.

Strategy Unit analysts tracked how patients in the participating practices moved through the healthcare system, comparing their journey to patients in 10 simulated GP practices made up of data from real local practices with similar characteristics.

Although A&E attendance rates were the same, the effects of the integration programme equated to a reduction of 74 unplanned hospital admissions and 14 unplanned readmissions per month, or 888 and 168 respectively, per year, amongst patients in the participating practices. Using NHS reference costs for an average unplanned hospital admission, the analysts estimated cost savings for the local Clinical Commissioning Group in excess of £1.7m per year.

Steven Wyatt, Head of Strategic Analytics at the Strategy Unit, said: “This is just one study, but it adds to the evidence around alternative healthcare models put forward by NHS England in its Five Year Forward View. While our analysis supports the vertical integration approach taken in this case, more research is needed to understand why this works and to determine the impact on patient satisfaction, health outcomes, and GP workload.”

Sultan Mahmud, Director of Innovation, Integration and Research at the Royal Wolverhampton NHS Trust, said: “This project was successful because it enabled the breaking down of silos between clinicians, as well as the intelligent use of data to drive care processes, while keeping the focus on patients. We continue to build strong relationships with all local GPs and partners and believe that this will allow us to redesign care processes and move to digitised, anticipatory care that is fit for the future.”