In Solihull, the Grove Road GP practice, a total purchasing project, and Solihull social services department have agreed to jointly purchase a bed in a nursing home for patients who may need emergency 24-hour care.

It costs 390 a week - 50 more than soical services would normally pay - but the GP practice has agreed to meet the cost for the first two weeks of the patient's stay. After that, social services have to foot the bill - or provide alternative community provision or long-term care.

'Previously, the GP would have had to a admit the patient to hospital, even though they didn't require medical care,' says social worker Jim Small, who is attached to the practice. 'And it avoids rushing people into residential care.'

One man used the bed because his wife, who was looking after him, was admitted to hospital. 'He had to be placed somewhere quickly at the weekend. There have also been one or two ladies who needed to be monitored, but didn't need to be in hospital.'

Having a social worker attached to the practice helps. 'Before, I would have covered a patch. Now, anyone from Grove Road practice is automatically referred to me. They get a far quicker service. GPs don't have to find a duty worker and I get far more information talking to nurses and GPs face to face.

'It's taken three years, but we now have a better understanding of each other's roles. We don't step on each other's toes. I don't tell them what to do if someone has a broken leg and they don't tell me what service is needed.'