When Mary Mills had a mini stroke and broke her hip and leg, following two successive bad falls last year, she decided to move into a nursing home. Since November, Mills, 74, has been resident at Willows Care Home in Romford, east London. Due to her ongoing health needs, Mills needs regular appointments with her GP, Dr Muna Sheikh. But she does not have to be taken to the surgery or wait weeks to be seen.
Willows is one of four nursing homes across the London boroughs of Barking and Dagenham, Havering and Redbridge taking part in a £400,000 pilot scheme. Jointly funded by the prime minister’s challenge fund (which awarded £50m to 20 pilot projects in England to improve access to general practice) and the local clinical commissioning groups, Health 1000 is a dedicated primary care practice providing 431 residents of the homes with 8am to 8pm, seven-days-a-week GP support, as well as training and advice for staff and help from a consultant geriatrician.
Crucially, the nursing homes are allocated a GP, directly employed by Health 1000, who visits the home each week. This is far from normal practice. Often, care home residents are registered with different GP practices, which do not always come out to care homes, or only provide phone consultations. In a review of the sector in 2012, the Care Quality Commission found only 38% of care homes had regular visits from GPs.
At Willows, where Sheikh spends every Friday morning, Mills says the regular contact is fantastic. “I’ve had quite a few things wrong with me,” she says. “Even if there is nothing wrong, she sometimes pops in to say hello. And I only have to say to the nurse that I want to see her and she comes.”
It is not just patients like Mills who are seeing the benefits. A new evaluation published on Wednesday by the health thinktank the Nuffield Trust found that in the three years to 2017 the scheme resulted in a 36% reduction in emergency admissions to hospital, and emergency bed days spent in hospital fell by 53%. These reductions in admissions are valued at up to £1,000 per patient per year.
The findings are especially striking, Nuffield Trust says, given that care home residents have between 40% and 50% more emergency admissions to hospital than the general population aged over 75. “One interesting thing about evaluating different schemes for keeping people out of hospital is it is rare to find such a big effect,” says Nigel Edwards, chief executive of the Nuffield Trust. “There are four times more people in beds in care homes than there are in hospital, so it is a very big part of the health and social care systems. It’s easy to say, well, they are in a nursing home so we don’t need to worry, but this scheme turns that on its head.”
One reason for the scheme’s success is that doctors such as Sheikh are able to really get to know patients and care home staff, meaning problems are often discussed before they escalate. “This kind of conversation is only possible because we have dedicated time in each nursing home,” says Sheikh.
Sheikh says the scheme has changed how she views her own job, after the wife of one of her patients who had dementia told the GP more about his personality when they were drawing up his end-of-life plan. “It made me realise the person I was treating was a human being who had a life and not just an advanced dementia patient who would never cooperate and would swear all the time,” she says. “Looking beyond that facade really made me think of how I could reach out more.”
Following the success of the pilot scheme, Jagan John, director of Health 1000, says preparations are under way to roll it out to all 39 nursing homes in the three boroughs, and other CCGs including Hertfordshire have shown an interest in replicating the model. “This is about the patient. It’s about what the patient needs in the moment you see them. It’s common sense,” he says.
Back in her room at Willows, Mills can’t praise the scheme enough. “When I was in my own home, it was often so difficult to get a doctor’s appointment and I didn’t always get the same doctor, which made me feel awkward,” she says. “I’ve had better care from Muna than any GP before.”
• This article was amended on 4 April 2018 to clarify that the reductions in admissions have been valued as being up to £1000 per patient per year, rather than providing a monetary saving to the NHS of £1,000 per patient per year.
