Professor Susan Smith:

There is a major opportunity in terms of emergency unplanned admissions because they are even more expensive than our patient referrals.

In June, an interesting study was published by the Deep End group in Scotland on a Care Plus intervention that was delivered at a systems level. The group gave more consultation time to GPs to manage complex patients in deprived areas and carried out an economic analysis. They found that the intervention was cost effective at a quality adjusted life year rate of £12,000, which is well below any of the funding thresholds that were used for any of our health service interventions. That relates to reduced hospital utilisation as well as improved well-being and improved health conditions for the individuals involved. There is evidence that if one targets one's resources effectively at these complex patients living in disadvantaged areas, one will save money for the whole system.