The Health service journal
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The closure of a casualty department provoked a crisis in Hillingdon in the winter of 1996-97. Worried by the publicity, elderly people contacted the health authority to ask what would happen to them if they became ill. An all-day workshop, attended by elderly people, chief executives, nurses, social workers and representatives from the community health council and ambulance services, led to several initiatives, including a rapid response home service, which helped prevent a crisis last winter.
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Integrated working between primary and secondary care has enabled one acute and community trust to reduce its emergency admissions by 8 per cent over three years. This has enabled the closure of 18 medical beds in this year's contracting round, with savings of over 400,000 Pounds. GPs and consultants have undertaken a process of peer review to identify doctors with high admission rates or inappropriate use of admissions.