Reducing unplanned admissions to hospital is now a cornerstone of the commissioning plans of all primary care trusts as the national health service struggles with a rising tide of emergency admissions and a large financial deficit. The management and care of patients with long term conditions has become a priority; in particular, intervention to reduce the number of admissions of frail elderly patients with multiple chronic diseases. In this week's BMJ, Roland and colleagues report the impact of the Evercare approach to case management for elderly people living in the UK.1

In 2002 the Department of Health started to fund innovative projects aimed at transforming chronic care and improving care for people with long term conditions, to reduce emergency admissions and, presumably, costs. The decision to pilot the Evercare model in 10 primary care trusts (PCTs) was based in part on a study from the United States which used nurse practitioners in a managed care programme that was directed specifically at long stay nursing home residents.2 It found the incidence of admission to hospital was twice as high in control residents compared with Evercare residents over 15 months with a …