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'Community consultants' plan for primary care unveiled

By Nigel Praities

A new grade of consultant should be created in primary care to provide faster access to specialist care, mentor GPs with special interests and ease pressure on hospitals, one of Lord Darzi's leading advisors has proposed.

Dr Mike Dixon, chair of the NHS Alliance, unveiled the plans for ‘community specialist consultants', which would be equivalent in expertise to hospital-based specialists, but with ‘training focused on prevention and the breadth of skills needed for primary care'.

But the alliance's proposals – recently submitted to Lord Darzi for his Next Stage Review of the NHS – were branded as ‘useless' by one expert, with some studies suggesting community-based consultants would be substantially more costly than those based in hospital.

Dr Dixon, a member of Lord Darzi's advisory panel, said it was not a question of dumping consultants into the community.

‘Its about better rationalisation of consultant time. If we do that and create that role and service then you're beginning to look at the cost effectiveness arguments that are raised by others.'

Dr Minoo Irani, a consultant paediatrician and NHS Alliance lead for specialists in primary care, said the plans would be on a similar scale to the GPSI scheme, with consultants employed directly by practice-based commissioning clusters.

‘What we are proposing is a new breed of doctors in training with a greater exposure to what happens in the community, as most long-term conditions can almost exclusively be managed now in primary care,' he said.

But Dr James Kingsland, chair of the National Association Primary Care and also an adviser to the Darzi review, said he had grave doubts about the idea. ‘There is no need for it and it is not any use. If we just go back to a system where we have better communication between secondary and primary care, and understand roles and responsibilities, we won't need these hybrid people.

‘Patients need the right person doing the right thing at the right time,' he said.

Shifting services into the community has proved controversial in the past, with the Government's drive to bring care closer to home criticised as ‘costly and unsafe' by a report last year.

Author of that report Professor Martin Roland, director of the National Primary Care Research and Development Centre, said the idea of more consultants based in the community was more of the same.

‘If they are without beds then they seem like an extended GP with a special interest. With beds, then it is just what we have already, with consultants coming out into the community,' he said.

Dr Mike Dixon: plans for new breed of consultants to oversee GPs Dr Mike Dixon: plans for new breed of consultants to oversee GPs

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