Intended for healthcare professionals

Rapid response to:

Education And Debate The hospital of the future

Better out than in? Alternatives to acute hospital care

BMJ 1999; 319 doi: (Published 23 October 1999) Cite this as: BMJ 1999;319:1127

Rapid Response:

GPled bed schemes offer another alternative

Hensher et al neglect to mention two other potent influences
encouraging the development of substitutes for hospital in-patient care.
These are a) the steady rise in emeregncy hospital admission rates (poorly
understood) and b) the steady reductions in numbers of acute hospital beds
(driven by Central Government policies in the name of improved efficiency.
Their emphasis is on hospital biased interventions such as the 'hospital
at home' schemes or the 'medical assessment unit'. This isn't surprising
since the hospitals seem to bear the brunt of the increased pressures.
There is, however, a model for a Primary Care driven intervention designed
to avoid emergency hospital admission of elderly people. An example of
this is a scheme that has been running in Huddersfield for the past three
years: the GP led bed scheme. GPs have the facility to admit suitable
elderly patients (acutely requiring 24hr nursing supervision, but not the
more advanced technology hospital provides)to a nursing home bed for up to
14 days under the clinical supervision of the GP.
Similiar schemes have been running in Bradford, Portsmouth, Bury and
Rochdale; but how common they are are nationwide is not known.
There are dangers; these schemes may be very expensive, they may not
provide optimum care, they may fuel demand (providing an additional rather
than an alternative service to hospital), and they increase primary care
We are planning an RCT (the GPECE, GPled Emergency Care of the
Elderly,Trial)to evaluate the cost-effectiveness of these schemes directly
compared to emergency hospital admission(a collaboration between the
Centre for Research in Primary Care in Leeds and the Dept of Health
Sciences and Clinical Evaluation at York)using an incremental cost-utility
ration as the primary outcome.
We would welcome enquiries from other centres interested in participating

Competing interests: No competing interests

29 October 1999
Owen Dempsey
General Practitioner
Fieldhead Surgery, Golcar, Huddersfield