Avoiding hospital admissions and reducing stays are ongoing priorities for primary care and acute trusts.

Avoiding hospital admissions and reducing stays are ongoing priorities for primary care and acute trusts.

In Sheffield, where the average cost of a medical admission for a person over 65 is£2,465, a new project is already showing results.

Work led by South East Sheffield primary care trust with Sheffield Teaching Hospitals foundation trust, on behalf of the city's four PCTs, is saving substantial sums by reducing the number of admissions, excess bed days and, consequently, medical outliers - medical patients on non-acute wards.

Since September 2005, Sheffield PCTs have saved£2.4m by reducing non-elective admissions by 1,200 - 2.1 per cent.

Excess bed days were down by 6 per cent in the last quarter of 2005-06, a saving of£1m, expected to rise to£4.1m in 2006-07.

The project has centred on partnership-working with the acute trust, making clear the financial incentives for all and linking in to the patient pathway.

Mutual trust and the low-key education of acute clinical staff by senior community matrons around treatment packages led the way for community nurses to work inside the hospital's bed bureau. Their role is to consider alternatives to admission following calls from GPs.

Emergency care practitioners respond to paramedics called to nursing homes to help assess whether community treatment is appropriate. That includes nurse specialists caring for patients with cardiovascular and pulmonary disease, with consultants providing support and advice over the phone.

The problem of excess bed days is being tackled by offering community services. Scrutiny of potential admissions and long-stay patients who could benefit from community treatment has resulted in a fall in medical outliers from 95 at this time last year to 10 in May this year.