22.10.14
Consultants can improve primary patient care – King’s Fund
Hospital consultants should dedicate more time to advising and supporting primary and community staff to better diagnose and treat patients, a King’s Fund report has suggested.
The think tank’s latest study, ‘Specialists in out-of-hospital settings’, is based on detailed research with six case studies (Portsmouth and South East Hampshire diabetes service; Leeds interface geriatrician service; Imperial child health general practice hubs; Sunderland dermatology and minor surgery service; Haywood rheumatology centre; and Whittington respiratory service) working in new ways to deliver care outside hospital.
One of the main findings was a “pressing” need to develop new roles for hospital consultants, who should spend more time working outside hospitals in multidisciplinary teams with primary, community and social care colleagues.
The report revealed that this approach can lead to better patient experience, improved management of chronic conditions and reduced waiting times, although it is unlikely to deliver significant cost savings.
Ruth Robertson, Fellow at The King’s Fund, said: “Our research uncovered great examples where hospital consultants working with their colleagues outside hospital has improved patient care.
“Implementing this new way of working is a challenge when budgets are constrained, the acute care workforce is focused on delivering consultant cover in hospital seven days a week and general practice is functioning under severe pressure. However, doing so offers enormous benefits to patients and brings the vision of a more integrated NHS that bit closer.”
To deliver this, the King’s Fund has recommended that national and local commissioners develop new funding models to motivate hospitals to keep activity out of their clinics; consultants and commissioners should also develop strong partnerships to drive forward service change; and there should be an investment in primary care so GPs and practice nurses can take on extended roles to provide more specialist care in their surgeries.
Gill Bellord, director of employment relations and reward at the NHS Employers organisation, said: “This is a useful report and we agree that consultant doctors have the potential to provide more care in a community setting, where it is best for the patient. Employers and consultants have shown their support for innovation - and the job planning process, both at team and individual level, is a good way of discussing and agreeing new ways of delivering services to meet ever-changing patient needs.
“This is early days and the NHS will want to explore relevant demand from commissioners and how training would be re-shaped to make this happen.”
The research found a number of approaches that supported the delivery of more complex care outside of hospital, including outreach clinics jointly staffed by hospital consultants and other health care professionals in which benefits accrue beyond the patients seen in clinic, as GPs and others gain confidence to manage similar cases themselves in primary care.
But Dr Paul Flynn, chair of the BMA Consultant Committee, said that consultants are open to different ways of working to deliver more patient-centred care, and many already work in the community alongside GPs and other healthcare professionals in areas such as public health, mental health and paediatrics.
“With the existing system under extreme pressure, and consultants as well as GPs struggling to meet rising demand, it is not clear how significant numbers of consultants could be moved out of hospitals without leaving some services dangerously understaffed,” he said.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, added that there is broad agreement that health and care services must be provided closer to patients’ homes to help keep them out of hospital, “yet we’ve seen a marked failure to invest in primary and community services so that this happens”.
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