Service can be provided by GPs and in the home

LITTLE investment would be needed to move around a quarter of Hinchingbrooke s caseload into the community – GPs surgeries, health centres and patients homes, where it could be delivered at less cost, the new primary care trust believes. In Peterborough

LITTLE investment would be needed to move around a quarter of Hinchingbrooke's caseload into the community - GPs' surgeries, health centres and patients' homes, where it could be delivered at less cost, the new primary care trust believes.

In Peterborough, collaboration between the hospital trust and PCT enabled both trusts to break even by closing several wards that had become redundant, Chris Town, then chief executive of Peterborough PCT and now interim chief of the Cambridgeshire trust, told The Hunts Post.

With the Peterborough and Stamford hospitals trust chief executive, Chris Banks, replacing Mr Town permanently in January, that policy is likely to be followed in Huntingdonshire - potentially leaving Hinchingbrooke with an even worse financial crisis.

"We wanted to get the balance of service and finance right by finding alternatives to hospital admissions," Mr Town said. "With an average ward costing £1million a year, any that were open unnecessarily meant I didn't have that £1million to spend elsewhere."

Hinchingbrooke, even after whatever changes emerge from the current review process, will retain a wide range of services, he insisted.

"But we have to have a radical re-think about just a few services. The difficulty lies in their interdependence. There's a recognition that things must change, but it must be clinically safe and financially viable."

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Some services have already moved away from the hospital, such as some dermatology to Dr Paulo Fargnoli's clinic in Buckden and podiatry to the new Oak Tree health centre in Oxmoor.

"We're not talking about big bucks kit such as x-ray machines and scanners, but electrocardiograms are routinely in doctors' surgeries. And much of what we are talking about could be delivered in patients' homes," Mr Town said.

The PCT wanted to build on two trends in particular - the move away from certain diagnoses and treatments being the exclusive fiefdom of hospital consultant, and a more holistic approach to elderly patients to prevent their needing to be admitted to hospital.

The exponential rise in the number of day-cases - a 341 per cent increase in 20 years in the number of patients who are out of hospital on the day of their operations or the following morning - has reduced the need for hospital beds. And some operations, such as correcting cataracts, are now carried out as out-patients' procedures.

In many cases, practice nurses can now do what used to be the preserve of specialist technicians, and trained receptionists could treat minor ailments, freeing GPs' time to devote to sicker patients, Mr Town believes.

But it is the increase in life expectancy that has put greatest pressure on the NHS, with 75 per cent of hospital beds across the country occupied by elderly patients. "If we don't give them the right support, they end up in hospital as emergencies. Which is better - to prevent them falling at home or give them a hip replacement?"

The benefit of freeing up GPs to give them adequate time with patients is that trips to hospital could be avoided completely in many cases. "GPs who can spend half an hour with a patient can often solve the problems themselves," Mr Town said.