GPs try new approach to patient care - including 30 minute appointments

Staff at Govan Health Centre, which looks after a deprived community near the new South Glasgow University Hospital (SGUH), initiated the project themselves in response to growing demands on the NHS including the rising elderly population.

Dr John Montgomery, Govan GP and project leader, said: "If all we do is carry on what we are doing then we better start building another new South Glasgow hospital right now."

The Scottish Government is funding the three-year trial, which Dr Montgomery described as "one of the first, hard examples of moving resources into the community".

It involves monthly meetings which bring together a wide range of health and care professionals, including hospital doctors, GPs and social services, to agree how best to look after vulnerable patients.

This will include identifying early elderly patients whose health is likely to deteriorate and vulnerable children who may need protection from problems at home.

Dr Montgomery said: "In general practice we are very good at identifying those frail elderly patients well in advance who are ultimately going to go into crisis."

At the new monthly meetings such patients are discussed. As much social care, therapy and equipment as possible is then provided to help the person remain independent.

However, an effort is also made to find out what care the patient and their family would like in future should their condition deteriorate. Should the pensioner need to go into hospital, it is hoped such preparation will reduce the chance of a long delay while their care is organised.

Dr Montgomery said: "Around 10 years ago we realised we had to reconfigure the way we deliver primary care to our patients. The more we looked at it, the more apparent it became that this could lead to benefits for not only patients, but also elsewhere in the health system and social care.

"We have developed a model where we identify patients who frequently attend one of the practices or hospital emergency departments and now tailor a healthcare package to best meet their needs."

Two extra full-time GPs have been appointed to Govan Health Centre to free up the experienced partners to work on the project.

This has also allowed the surgery to set-up a system where the new hospital accident and emergency department can divert patients who show up with a problem that can wait, back to their GP. Instead of sitting in the A&E waiting room, patients from Govan Health Centre have the choice of being telephoned the next morning by a GP and offered a rapid appointment.

Management plans for patients who repeatedly use the A&E and out-of-hours medical service are being formulated at the monthly meetings too. Already doctors across all the different NHS services have agreed how to manage a patient who was repeatedly seeking medical attention, resulting in more than 100 x-rays being taken in one year. Long GP appointments are being made available for patients with complex problems.

Dr Montgomery said links between GPs and hospital doctors had "kind of broken" but it was more important than ever to start reforming them.

All parties can flag up a patient to be discussed at the monthly meetings including voluntary agencies and social workers, who have been especially attached to the health centre.

Dr Montgomery said staff are enthusiastic about the new system, which began in April and will cost £290,000 in its first year.

It is being evaluated by experts at Glasgow University including Professor of General Practice Graham Watt. He said there was already a "buzz and energy" about the project and research into such initiatives needed to be "expanded urgently".

Dr Fraser Benny, consultant in emergency medicine at the SGUH, said the number of elderly patients was putting pressure on major hospital services, but by working with GPs and community services there was the chance to "reduce unnecessary hospital admissions and investigations" for this group.