Senior specialist doctors have demanded an overhaul of outpatients care, emphasising the need to work closely with GPs and shift resources to the community.
The Royal College of Physicians (RCP) has today published a report calling on the Government to commit to reforming ‘archaic’ and ‘ineffective’ NHS outpatient services as part of the upcoming 10-year plan.
GP leaders have backed their specialist colleagues’ recommendations, with the RCGP highlighting that GPs ‘see at first-hand the huge impact that a disjointed outpatient system’ has on patients.
The RCGP also said that general practice ‘can take pressure of the entire health service’ but it must be properly resourced in order to do so.
The report recommended the uptake and expansion of ‘novel outpatient pathways’ such as advice and guidance (A&G), group clinics including GPs, and multidisciplinary teams in the community.
On group clinics, the RCP said a ‘collaborative approach’ should include general practice to allow these new models to ‘support personalised care and continuity of care’.
‘GPs play a particularly important role due to their expertise in delivering continuous whole person medical care,’ the report said.
It also supported the Government’s commitment to shift more care into the community, saying that ‘care should be delivered as close to the patient as possible to increase accessibility and reduce health inequalities’.
The report said: ‘Integrated community services can provide diagnosis and treatment for conditions in community settings […] This could include support from secondary care teams to manage patients in primary care where appropriate, such as through advice and guidance or multidisciplinary meetings with primary and secondary care.’
But the RCP stressed that for any ‘new local commissioning models’ that facilitate this way of working, it ‘will be necessary for resource allocation to shift to the community to support this’.
Senior specialist doctors also highlighted the need for clinicians to improve the interface between primary and secondary care in order to ‘ensure good practice around handovers of care, including prescribing and safe and appropriate communication to GPs and patients’.
‘Clinicians requesting a test are responsible for actioning the result and initiating specialist medication,’ the report added.
In response, RCGP chair Professor Kamila Hawthorne said that GPs ‘need to know’ the right support will be available for patients when referring them, and that often patients are ‘bounced back’ to general practice or become ‘more unwell’ while on long waiting lists.
‘This is why we support the RCP’s recommendations for improvement,’ she said.
Professor Hawthorne continued: ‘It is also encouraging to see further support for the “hospital to community” shift that the Government has committed to, we know this is both cost effective and what patients want. If properly resourced, primary care can take pressure off the entire health service.
‘However, funding must follow the patient if GPs and our teams are to achieve this, and we need to see real investment in general practice so we can deliver safe, timely and appropriate care to our patients close to home.’
Earlier this year, the Government announced funding for GPs to carry out advice and guidance in a bid to bring down the elective waiting list. The £80m funding pot – which allows for £20 per A&G request – has been taken from secondary care budgets.
RCP clinical lead for outpatients Dr Theresa Barnes said that NHS outpatient care is ‘fundamentally no longer fit for purpose’ and has ‘remained largely unchanged for decades’.
‘It is archaic, disjointed and ultimately ineffective for both patients and staff,’ she said.
Dr Barnes continued: ‘We need a significant shift in the way we deliver planned specialist care. Getting this right is integral to bringing down NHS waiting lists and delivering the government’s three shifts. Now is the time to be radical.’
Fine. Where’s the staffing, funding and training?
as long as EXACTLY the same funding follows it rather than trying to get it done on the cheap. Maybe they could also keep some of their own work too (please chase this arrange that, make me a cup of tea (ok – i exaggerated on the last one)).
Wow how nice of them . All the talk of setting up more community services just doesn’t happen and is being stopped by lack of ICB funding. If this is happening no way we will be given more funding to do secondary care work . Maybe easier if we send our work their way as they have greater % of budget .
No problem if the funds follow, but that is unlikely to happen. On another note has anyone seen the minor surgery DES?! Payments for joint injections and procedures are the same as they were 15-20 years ago.( example : https://gps.northcentrallondon.icb.nhs.uk/cdn/serve/user-7/1453217988-bbab36c7d935aaaaa5300f5bb41d21e2.pdf , https://www.escro.co.uk/trusts/highland/documentation/slas/SOUTH%20AND%20MID/hi_min_surgery_sla.pdf). Who negociated this ?!, what about inflation. Why is it that we are expected to pay more to staff, pay more for equipment, membership fees, but our payments for contracts are fixed for 15 to 20 years.
Another attempt to shift work to primary care without any thought of how it will work. Primary care is in any case picking up the pieces of inefficient and careless outpatient services. In the first instance, improving the appointment system will help and that’s simple logistics really. I get that RCGP accepts this idea in principle. My worry is that this will be accepted as acceptance and work will be further shifted our way WITHOUT the funding, training and support.
So, are we saying that specialist consultants—like neurologists, endocrinologists, and colorectal surgeons—will now be doing their telephone appointments from inside a GP surgery? I’ve seen quite a few telephone consultations from hospital-based consultants—are they supposed to conduct those calls from the GP practice now? That would be interesting… and quite something to see!