case study
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GP to provide this cover. In order to provide the carpal tunnel release service, we had to invest. This has included investing in a salaried GP post, providing staff training to doctors and nurses and upgrading the minor surgery suite.
What are the cost savings for the local NHS? Over three years, offering the service at the practice will save the local NHS around £150,000. In terms of costings, when a carpal tunnel syndrome patient has their assessment and operation carried out at hospital, this is charged at the national tariff which works out at around £1,000-£1,200 per patient. In comparison, when carried out at the practice, the charge is just £550. After carrying out over 120 operations in our second year, we will have saved the local NHS around £700-£800 per procedure. This money can then be reinvested back into other healthcare services.
How does offering the operation at the practice affect patient waiting times? Previously, all patients affected by carpal tunnel syndrome, a condition which causes pain and weakness in the hand due to pressure on a nerve in the wrist, would have been referred to the orthopaedic department at the local hospital. The practice follows a very strict referral
protocol which includes looking at the symptoms and condition of the patient. The service the practice offers has been set up under Choose and Book, when patients require the operation, we are one of the five local provider choices available. The majority of patients tend to prefer a primary care setting which is familiar and convenient to them. Our waiting time is shorter from referral to procedure, as patients are generally seen within six weeks under our See and Treat model. The local hospital’s target time is eight weeks for the first outpatient appointment.
What is the involvement of the qualified surgeon’s clinical supervisor? The practice’s clinical supervisor is Mr Malcolm Podmore from North Devon District Hospital. When the first procedure was carried out by Dr Loka, the clinical supervisor was in attendance. The clinical supervisor now meets with the GP surgeons every six months to undertake twice yearly audits where they will discuss audit data and
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patients. Each audit will look at the clinical outcome of the patient and whether there were any complications. This data is then collected and sent to the PCT for contract monitoring in terms of quality.
What feedback have you received from patients so far? Feedback has been extremely positive; one patient even commented on his satisfaction survey that the practice’s service was the NHS at its finest. Audit results also show a very high level of satisfaction too. Patients are particularly pleased with the reduced waiting times, the clear explanation of the procedure and having the service closer to home. For some patients, depending on where they live in Bideford’s surrounding area, they may have to travel 30-40 miles just to access the local hospital, which is around 10 miles from Bideford. When they choose to have the operation carried out at the practice, the location could half the distance and their journey time.
Could you tell us more about the awards the practice was recently shortlisted for? I submitted nominations for our service under different categories of the General Practice Awards 2012. These were for Innovators of the Year, GP Provider of the Year and Commissioner of the Year. The third nomination was submitted on behalf of NHS Devon as the service commissioner. The practice was a finalist for GP Provider of The Year and NHS Devon was also a finalist for Commissioner of the Year. Those that had worked hard to provide the service from both the practice and PCT went along to the awards ceremony and were delighted to be presented with certificates for reaching finalist status in the two categories. The practice’s finalist certificate is now framed and proudly on display in the staff room.
Do you feel offering the service has been worthwhile for the practice? Most definitely. Discussions were held in GP partner meetings for 18 months to answer all questions before getting to the business plan. All of the GP partners feel that we provide a high quality service that is of value to patients. The practice can offer the service in a safe environment that meets all the standards in a comfortable setting for patients, which is closer to their homes.
Our forecast was to do 80 procedures in the first year, 100 in the second and 120 during the third. We have carried out just over 120
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