Finance - Claremont Medical Practice in Exmouth, East Devon

The team at Claremont Medical Practice in Exmouth, East Devon, has been overseeing its own hospital services budget for two years. An integrated nursing team was developed through personal medical services contracts with no difference between the practice and community nurses or healthcare assistants - just one team of 14 to provide the nursing services for 10,700 patients.

Practice-based commissioning was the ideal way forward to develop the aims of the practice -namely better care for patients, delivered locally with efficiency gains to encourage service redesign.

The team is committed to reducing the long-term effects of chronic disease. To reduce emergency admissions, a whiteboard in the nurses' room is used to create an 'at risk' register that gives a red, amber or green status of any patient who the doctors or nurses are concerned about. The patient is assessed using the single assessment process that is carried out as soon as they are identified.

The scenario of the GP visiting a failing patient at home before an overbooked afternoon surgery, which would previously have led to a 'social' hospital admission, now has another outcome. The doctor can call one of the nursing team or an attached social worker on a mobile phone for a quick response. This often means hospital admission can be avoided.

The intervention leads to the involvement of our rapid response team, local rehabilitation unit or community hospital. With admissions costing an average£2,500, this is a win-win situation for our patients and our budget.

Patients and their families wholeheartedly support this plan to avoid admission. The extra nursing and social worker hours - 20 in both cases - are funded by East Devon primary care trust as an 'invest to save' project with a supporting business case.

The final aim is to create savings. Every admission letter to hospital has a 'virtual cheque' attached that gives the hospital permission to debit whatever amount it feels is reasonable to deduct from the budget.

Discussions around this take time, and management costs are funded by the PCT to finance monthly half-day meetings.

At the end of 2005-06, we realised a£440,000 saving on our budget and reduced emergency admissions to our local district general hospital by 15 per cent " particularly significant when the national trend for admissions showed a 6 per cent increase.

Dr Tom Debenham is a GP in Exmouth. Tom.Debenham@gp-L83056.nhs.uk