Reform medical education to shift NHS work into primary care, says report

A fundamental overhaul of medical education will be needed to shift care out of hospitals and into primary and community care, a King's Fund report has said.

King's Fund: calling for overhaul of medical education

The report, Specialists in out-of-hospital settings, published on Wednesday said any such shift in care would result in a huge change to the case-mix and complexity of GPs’ workloads. 

The think tank's research analysed six case studies that have pioneered the use of hospital consultants in roles outside their traditional hospital setting.  It found that those consultants were used to fill a ‘skills gap’ where care had been moved away from the acute sector, but it concluded that this was only a short-term solution.

Among the schemes the King’s Fund looked at were: outreach clinics where consultants work with other clinicians including GPs; consultant-run email and telephone helplines that provide advice for GPs, nurses and others; consultant participation in multi-disciplinary team meetings; and consultant-run education sessions including one-to-one sessions for GP practices.

GPs with special interests

The King’s Fund said that more of this type of work would lead to a greater role for GPs with special interests who would treat more complex patients in surgery, and within intermediate care services.

It also pointed to a new consultant role spanning secondary, primary and community care, and it said groups of GPs could employ consultants as part of multidisciplinary teams.

The report accepted that general practice was currently under great pressure, and that GP time and funding would be needed. And it said that although financial savings were not the main aim of this innovative work, if it was to become more widespread then NHS commissioners must work to develop new joint tariffs, financial incentives and collaborative funding models to motivate hospitals to keep activity out of their clinics.

GPC deputy chairman Dr Richard Vautrey said: ‘These recommendations are in line with what GPC was calling for in its own report "Developing general practice today, providing healthcare solutions for the future", which called for teams to be built around the practice.

‘Such teams would include specialists from the hospital spending more time in the community working with GPs. This would help to break down the current barriers between primary and secondary care and can support GPs who have a special interest.  Patient satisfaction with these community based services is also high.’

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