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Kings Fund - Consultants need to spend more time outside hospital, report finds

Specialist knowledge is too concentrated in hospitals, to the detriment of those patients whose increasingly complex needs should be treated closer to home, our new report finds.

The report is based on detailed research with six case studies working in new ways to deliver care outside hospital. It found 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. One of the strongest messages in the report is that this should include supporting and training other health and care professionals to enable them to provide more specialist services closer to people’s homes.

The report found that this approach can lead to better patient experience, improve management of chronic conditions and reduce waiting times, although it is unlikely to deliver significant cost savings. Spreading these ways of working will require significant change and needs commitment across the local health and care system. To make this a reality, the report makes a number of recommendations.

  • National and local commissioners must develop new funding models that motivate hospitals to keep activity out of their clinics. Current incentives, like Payment by Results, can act as a barrier to developing integrated care by incentivising activity in hospitals.
  • GPs and practice nurses will need to take on extended roles and provide more specialist care in their surgeries. This will require initial investment to increase capacity in primary care but may relieve pressure in the long term by improving diagnosis and treatment.
  • Consultants and commissioners should develop strong partnerships to drive forward service change. Commissioners must act as a bridge between local organisations, consult with stakeholders and pilot new approaches. 
  • Transition funding should be made available to allow services to be piloted, evaluated and refined. 
  • Robust economic evaluation data must be collected on the impact of hospital service models across the whole local health system. 
  • New services must provide placements for trainee doctors to prepare them for working in different settings in a more integrated care workforce.

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.’

Notes to editors: 

The report is called Specialists in out-of-hospital settings: findings from six case studies.

The case studies are as follows:

The research found examples of the following educational approaches that support the delivery of more complex care outside of hospital:

  • 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
  • consultant-run email and telephone helplines that provide advice for GPs, nurses and other health care professionals to enable them to better diagnose and treat patients in primary care or make more appropriate referrals
  • consultant participation in multidisciplinary team (MDT) meetings, which brings specialist input into the management of patients in the community and facilitates joint learning
  • consultant-run education sessions, for instance, one-to-one sessions for GP practices on topics of their choice, education sessions at MDT meetings, and education sessions for GPs and other health care professionals across a clinical commissioning group (CCG)
  • consultants supporting staff to work in extended roles by leading intermediate care services that enable nurses and other health care professionals to run clinics that would elsewhere be staffed by doctors.
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