Southbury Surgery in Enfield, North London implemented a Unique Care pilot from July to November 2006. Dr Patrick Keating started by identifying older people at high risk of hospital admission using the EARLI Tool questionnaire (Lyon et al, 2007).

A community matron and social worker worked together for seven hours each week proactively case-managing the ‘very high' and ‘high' risk patients in the community. They also provided hospital in-reach for newly admitted patients, organising packages of care to facilitate early discharge.

The results of 22 week study were:

• Emergency admissions reduction - 50% (12% in comparator practice)
• Excess bed days value reduction - 98% (23% in comparator)
• Spells value reduction - 49% (6% in comparator)
• Total budget savings - 67% (9% in comparator)
• Total budget savings over 5 months = £99,000
• Estimate over 1 year = £237,600

Benefits for patients included:

• More patient-centred, coordinated care
• Single point of contact
• Improved quality.

Benefits for staff included:

• Appropriate contacts and improved communication
• Fewer admissions and crisis situations
• A reduction in GP home visits
• Increased job satisfaction.