By Marino Donati | 22 October 2014
Specialist knowledge is too concentrated in hospitals and patients’ increasingly complex needs should be treated closer to home by consultants spending more time in community care settlings, the King’s Fund has said.
The think-tank’s Specialists in out-of-hospital settings report called on consultants to spend more time working outside hospitals in multidisciplinary teams with primary, community and social care colleagues.
They should also support and train other health and care professionals to help them provide more specialist services closer to people’s homes.
This could lead to better patient experience, improved management of chronic conditions and reduced waiting times, the report says. However, it acknowledged that the change would be unlikely to deliver significant cost savings.
The study is based on research into new ways to deliver care outside hospitals, including findings from six case studies.
Examples of care delivery outside of hospital covered in the case studies include outreach clinics jointly staffed by hospital consultants, consultant-run email and telephone helplines and consultant-run education sessions, including one-to-one sessions for GP practices on topics of their choice.
The King’s Fund says these new ways of working would require significant change and needs commitment across the local health and care system.
Ruth Robertson, a fellow at the think-tank 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.’
Other recommendations in the report include that national and local commissioners must develop new funding models that motivate hospitals to keep activity out of their clinics, and encourage consultants and commissioners to develop partnerships.
Transition funding should be made available to allow services to be piloted, while robust economic evaluation data must be collected on the impact of hospital service models across the whole local health system.
Responding to the report, Gill Bellord, the director of employment relations and reward at the NHS Employers organisation, agreed that consultant doctors had the potential to provide more care in a community setting.
‘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,’ she said. ‘However, the systems behind how they work needs to be modernised and quality care delivered in a cost-efficient way. So more work will be needed to take this forward in a sustainable way.’
