The article by Andy Levy and colleagues about medical readmissions ('We'll meet again', pages 30-31, 5 October) was a timely reminder that hospital-based problems may have whole-system solutions.
In Manchester we have a protocol, within our supported-discharge service, which deliberately asks GPs to consider alternatives to readmission, such as timely phone consultations with registrars and rapid access to review in clinic.
It may well be that improved post-acute care in the community will permit more timely intervention when patients are less ill, thereby avoiding some readmissions.
Alongside more effective surveillance of vulnerable groups it may be possible to have a significant impact on 28-day readmission rates. This sort of approach can only be tested with substantial remodelling and resourcing of elderly services in both hospital and community.
It is to be hoped that the forthcoming national service framework for the care of elderly people will give us both an opportunity and a lever to achieve this.
Dr Peter Fink Director of intermediate care Manchester health authority