As GP reports this week, ministers and policy-makers are currently considering 'enhanced recovery' as a way to save money.
Practices would ensure a patient was in good physical shape before being admitted for an operation, thereby reducing the recovery period and expensive post-operative hospital stay. GPs would, quite likely, also have a greater role in post-operative care in this scenario.
In theory, this sounds like a good idea. But, as with so many things, how it is implemented will determine its success. This would require a great deal of extra work from practices and possibly involve recruiting more staff. But would GPs receive the necessary funding to do this?
Last week, GP reported that the DoH wants GPs to lead the NHS efficiency drive. Practices are the ideal place to deliver public health and innovation from GPs could help move more care out of expensive hospitals - enhanced recovery fits into this vision.
But, to achieve this, money needs to move from secondary care to general practice - and this may involve extra investment to begin with. The DoH may need to fund two services in tandem before primary care can take on the work from secondary care.
The NHS has a poor track record in this area. And, with the government (and the Conservatives) seemingly determined not to pay GPs any more than they currently receive in core income, other incentives and means of payment will need to be found.
A local enhanced service could work, but these are particularly susceptible to cuts. Practice-based commissioning is another option, but in some areas take-up is poor and support from PCTs is woeful.
However, money has to move into primary care if services are to successfully shift settings. If extra money is needed initially, this would be a wise investment. Paying practices more to enable them to innovate could, in the long run, save the NHS billions.