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Care closer to home 'costly and unsafe'

The Government's flagship policy to shift care en masse from hospitals to primary care will in many cases lower quality and increase costs, a damning NHS report concludes.

Its findings shatter the assumption that care 'closer to home' will necessarily be safe, cheaper than hospital care or popular with patients.

There will only be concrete benefits for rural areas and in a small subset of initiatives, warns the wide-ranging analysis commissioned by the Department of Health.

The report comes as consultant leaders claim as few as a third of GPSIs may be competent to take on work from specialists.

It finds a few policies – including telemedicine and direct GP access to diagnostic tests – can reduce demand on hospitals and maintain quality.

But in many other areas, including minor surgery, specialist clinics in the community and GPSI clinics, services are likely to be more expensive and potentially less safe than hospital care.

In Our Health, Our Care, Our Say, the department insisted some primary care procedures cost only a third of those in hospitals, with potential to 'considerably' reduce demand for specialists.

But the report, a comprehensive review of evidence for transferring care to the community, casts a long shadow over those claims.

'The paucity of high-quality research for any one intervention was striking,' it says. It is 'often not the case' that care in the community is cheaper than hospital care and 'not true' services like minor surgery can safely be transferred to GPs, it warns. It also concludes there is 'a serious risk that increasing provision may increase demand'.

Report author Professor Martin Roland, director of the National Primary Care Research and Development Centre, said shifting work might only be beneficial where access to hospital was difficult – such as in rural areas. 'It should be applied selectively where patients will benefit.'

Professor Roland, a GP in Manchester, said protocol-based work tended to transfer well, but added: 'Some things we need to be more cautious about.'

Professor Roger Jones, professor of general practice at King's College London, said: 'If you're working in the Scottish islands, there may be a rationale, but the arguments in some cases are pretty weak.'

The Department of Health insisted: 'We hear time and again most people want an NHS that provides services closer to home. It's better for patients if chronic conditions are dealt with in the community.'

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