Hinchingbrooke: The changes

CAMBRIDGESHIRE Primary Care Trust says the proposed way of working will not just save money but will be welcomed by patients, many of whom will have to travel less far, and by GPs, who will have a more varied professional life. We propose a significant s

CAMBRIDGESHIRE Primary Care Trust says the proposed way of working will not just save money but will be welcomed by patients, many of whom will have to travel less far, and by GPs, who will have a more varied professional life.

"We propose a significant shift of work away from the hospital setting and a major re-investment of up to £2.5million in community services, making these more accessible by bringing them closer to people's homes where it is clinically safe and appropriate to do so," the PCT said yesterday.

"This is good news for local people and would enable the hospital to focus on providing services that only it can provide, while reducing the current high levels of demand for hospital services from a relatively healthy population."

But it cautions: "Such a shift in service provision would not be possible without a change in patient expectations and behaviour regarding the setting in which they receive certain services".

Medical advances mean that procedures which required complex hospital facilities a few years ago can now be carried out effectively in the community or even in the home, it says.

Huntingdonshire patients use hospital services more than any other area in England, and the proposed new arrangements will save them having to travel to Hinchingbrooke for a brief consultation that could be carried out by a less-busy GP or by a consultant visiting a GP surgery or health centre.

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Some GPs already provide consultations for other practices' patients in areas in which they have a special interest, including dermatology and gynaecology.

The PCT proposes dressings clinics in the community, pointing out that dressings can be changed safely and more conveniently by clinicians near patients' homes.

For elderly patients, there will be new "intermediate care" services, bridging the gap between home and hospital, and either keeping patients out of hospital completely or getting them out sooner. There will also be more social carers, district nurses and therapists to underpin more care in patients' own homes.

Community matrons will be introduced to help streamline many of these processes and ensure care and treatment are properly managed.

The trust reminds Huntingdonshire folk that Hinchingbrooke does not currently provide the full range of A&E services. Patients with major, multiple trauma are diverted by paramedics and/or Magpas doctors away from Hinchingbrooke in favour of specialist services at Addenbrooke's or Peterborough hospitals.

"We are proposing that a consultant-led emergency care centre would provide the same range of services that are currently provided. Access to treatment would be speeded up by the introduction of an emergency nurse practitioner who will direct patients to the appropriate clinician or service," says the trust.

"The current medical assessment unit, A&E bays and resuscitation facilities would come together to become one 'clinical decision unit', again with direct access to appropriate clinicians and services. Minor illnesses or injuries would be treated by an emergency nurse practitioner and/or a GP."

Surgery will be increasingly concentrated in the £22million treatment centre, which now plays host to the 80 per cent of operations taking place as day-cases. Shorter hospital stays expose patients to lower risk of infections such as MRSA.

Apart from no longer treating curvature of the spine surgically, there is no change proposed to trauma and orthopaedics treatment. There are no plans to change cancer services or medical specialities, although the current five wards can be reduced to four as the hospital "footprint" diminishes.

It has long been the plan to close the three remote wards at the southern end of the site, moving patients into the main hospital, closer to services such as X-ray. The hospital might then be able to sell some of the surplus land or buildings to help reduce the debt.

Apart from a possible re-designation of the special care baby unit to care for less sick babies, no changes are planned for children's services. A new PCT-funded paediatrics centre is due to open in May, freeing Holly Ward for adult patients.

Maternity services will be strengthened by community midwives, who will offer Hinchingbrooke's services to expectant mums from further afield. Cambourne, in particular, will be an early target, and the rapidly expanding population of the district should in future fill the gap between the current 2,400 births a year and the 3,000 target for a clinically efficient and financially viable unit. In the meantime, the PCT will fund the £1.1million annual deficit.

A new consultant e-mail service will be introduced, so that GPs do not refer patients unnecessarily, following a successful trial with dermatology consultants.

Out-patient follow-ups will be done on the telephone in many cases.

The PCT has also identified efficiencies in radiology, medical records, pathology, anaesthetics and procurement - where central buying of examination gloves is already saving £30,000 a year.

Nearly £1million of the savings will be delivered by reductions in management costs, including abolishing the Hinchingbrooke trust from April 2009. There will be a further consultation on what should replace it.

Financial balance should be achieved in 2009/10. How to deal with the debt will be for another time.

Hinchingbrooke FACTfile:

Income: £62million (96 per cent from Cambs PCT, four per cent from neighbouring PCTs)

Deficit: Predicted £29.9million at March 31 2007

Cumulative deficit (including historic debt): £39.2million at March 31 2007

Required savings: £14.5million for break-even.

Catchment: 161,000 in Huntingdonshire

Employees: 2,000 (many part-time)

Beds: 310 adult, plus 25 paediatric and 12 special care baby unit cots (PCT-funded), two mental health wards (Cambridgeshire & Peterborough Mental Health Partnership-funded)

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