Six specialties shift to primary care

White Paper - Secondary care in GP surgeries, APMS contracts for deprived areas and social care links.

GPSIs are set to take over work done in outpatients departments under White Paper proposals to shift hospital work into the community.

The DoH wants to shift 5 per cent of the total NHS budget into a new breed of community hospital and primary care over the next 10 years.

Six clinical areas have been earmarked for a move to the community. These areas are dermatology, ENT, general surgery, orthopaedics, urology and gynaecology.

Consultants in these areas will run some outpatient clinics in primary care centres and community hospitals, training GPSIs to see many of the patients.

This will free up consultants so their skills can be better utilised.

Exact details of GP involvement have yet to be worked out by the DoH in collaboration with the RCGP, the Royal College of Physicians and other specialist bodies.

Over the next 12 months, care pathways for providing simple diagnostic tests, step-down care and outpatient follow-up outside the acute hospital setting, are going to be piloted in 20-30 'demonstration sites' involving around 1 million patients.

Tariffs 'related to the cost of care or treatment in the community rather than the acute setting' will be set, suggesting that the DoH believes the primary care approach will be cheaper.

However, RCGP chairman Dr Mayur Lakhani warned the shift would require extra investment to reduce waiting times and improve patient care.

'GPs cannot be expected to do this extra work without serious investment in training and adequate facilities,' he said.

Health secretary Patricia Hewitt said: 'Community facilities should not be lost in response to short-term budgetary cost cutting. We are asking PCTs to reconsider them in light of the White Paper.'

The DoH has also said it plans to create a new wave of community hospitals that combine their traditional functions with that of GP practices, diagnostic centres and other services.

Health minister Lord Warner said there was DoH capital funding for the refurbishment or new build of 50 community hospitals.

Former GPC premises subcommittee chairman Dr Grant Kelly said: 'If the government thinks it's cheaper than doing this in hospitals, they are wrong.'

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