How to run a profitable minor injury service

GP partner and specialist in sports and musculoskeletal (MSK) medicine Dr Ralph Mitchell outlines what a minor injury service involves and why it can be a lucrative option for practices

Our CCG has set up several services aimed at enhancing patient care, while ensuring treatment plans are cost-effective. These services utilise the skills and knowledge in primary care to prevent unnecessary A&E attendances and provide continuity of care within the community.

One of these services is a minor injury scheme, which incentivises practices to treat minor injuries that may otherwise require attendance at A&E or secondary care, such as MSK injuries without suspicion of fractures, wound care and suturing.

What are the requirements?

The requirements for this service are basic routine primary care facilities and skills. It requires practices to offer appointments to patients who might otherwise go to A&E and therefore be more appropriately dealt with in primary care.

Staff need basic understanding of diagnosis and management of minor injuries.

Appointments are integrated into routine practice hours (or extended hours, if there is patient demand) and are usually the same duration as normal appointments, ie, 10 minutes.  

The payment is per presentation of the injury to primary care.

What is the funding?

In our area, the current enhanced service employed by Leicester, Leicestershire and Rutland Partnership offers a fee of £15 per minor injury seen and £40 for stitching of a wound that would otherwise need to go to A&E.

You can also look up the Pulse Intelligence local services section to understand how much other areas are paying for minor injury services.

There is no time limit from when the injury occurred to when the patient presents to primary care, which therefore allows practices to claim for services even when the patient has tried self-help measures.

From a commissioner’s perspective, this is clearly a big saving when compared with the typical costs of A&E attendance for a patient, at around £138 irrespective of any onward or further care needed, or the severity of the injury according to figures from the Health Foundation (healthfoundation.org).

The scheme is also a good source of income for practices, and is satisfying for patients.

On average, a GP may see two or three minor injury presentations per six-session week.

Injuries that are eligible range from a small abrasion that may just need advice, to wound closures, burns, bruising and soft tissue injuries such as pulled ligaments. In theory, any minor injury is claimable, so long as the patient hasn’t presented to A&E already with it and the injury is within the scope of primary care (not major trauma).

In some circumstances, the number of presentations could be higher.

In a practice of, say, five GPs, along with ANPs and nurses, the payments can add up to several hundred pounds per week.

How to staff the service

Providing this service is fairly straightforward, as it draws on skills already available in primary care – especially if you employ a GP with special interest in urgent care or MSK medicine. For example:

• An MSK specialist GP can see soft tissue and sports injuries, advise around rehabilitation and liaise with physiotherapy.
• A practice nurse with a specialist interest in wound care can deal with simple lacerations and burns.

This also adds to the general practice skill base, because the GP will be seeing interesting acute presentations, at the same time as maintaining abilities and interests.

The patient is being provided with better care than what may be available in A&E, but at a fraction of the cost.

How to run it efficiently

All equipment needed for basic wound care is already available in primary care stocks in surgeries, so the service shouldn’t require any additional expensive purchases.

Doctor and nursing appointments must be allocated to the service. Some practices use duty doctor and same-day urgent nurse slots.

The exact number of appointments is dependent on list size and population mix, but could reach 10-15 appointments a day.

Ensuring the correct coding is an essential but straightforward task. Each consultation for a minor injury is coded to ensure data collection and payments (such as 9kb on emisweb).

Training

If you don’t have the in-house experience, there are short courses available, such as GP minor surgery and basic wound care.

The RCGP runs accredited courses to learn minor surgery and MSK skills.  

Ensuring uptake

It’s important to advertise your service to patients, to advise them to see the GP instead of visiting A&E for basic injuries. When doing so, emphasise that this doesn’t include fractures or complex injuries.

Signpost patients using the practice website, text messages or reception.   

Your minor injuries service could also be the first step to building a more specialist service for your locality, such as an MSK and sports injury clinic.

To further boost uptake, some practices within federated working may be able to pool their skill mixes together and offer appointments during their extended hours access.

These actions require relatively little or no financial outlay, but can potentially be lucrative. At the same time, they provide high-level patient care and boost the practice’s reputation.

Dr Ralph Mitchell is a GP partner and specialist in sports and musculoskeletal (MSK) medicine practising in Leicestershire