GPs should receive additional training and support from hospital consultants to help them manage more complex conditions in the community, a think-tank has recommended.
An analysis by the King’s Fund argues that to have any impact on hospital admissions, commissioners must invest heavily in general practice to enable GPs to attend training, and suggests they consider closing hospital clinics where activity has shifted to the community.
The report Specialists in out-of-hospital settings draws from six long-term case studies where different regions have trialled programmes encouraging specialists to work in the community, improving GP proficiency and preventing admissions.
The report said: ‘General practice participation was key to the success of a number of these initiatives, but heavy workloads meant it was often difficult for GPs to take part.
‘Funding arrangements that enabled GP engagement were key to overcoming this barrier in some sites.’
In the pilot areas GPs’ time was funded to allow doctors to attend multi-disciplinary team meetings alongside consultants, or consultant-led training on a specialism. Some areas used local enhanced services to incentivise GPs to diagnose conditions like COPD and manage them in the community.
Meanwhile, a scheme in Leeds allowed GPs to call or email a consultant helpline to aid diagnosis.
The report concluded that, for changes to be beneficial, commissioners should implement schemes on a scale ‘sufficient to allow – for example – hospital clinics to be closed in response to the increase in care outside hospital’.
It added: ‘The findings have major implications for the primary care workforce, who will be asked to take on extended roles and provide more specialist care in their surgeries.
‘Following the initial investment, initiatives that help GPs manage the more complex cases in their workload may eventually relieve capacity pressures on primary care by helping clinicians get their treatment and diagnosis right first time.’
King’s Fund fellow Ruth Robertson said: ‘Implementing this new way of working is a challenge when budgets are constrained, the acute care workforce is focused on delivering consultant cover in hospital seven days a week and general practice is functioning under severe pressure.
‘However, doing so offers enormous benefits to patients and brings the vision of a more integrated NHS that bit closer.’