Care closer to home--a changing role for physicians?

摘要

Consultants have for some time worked in both primary and secondary care, eg community paediatricians and geriatricians bringing specialist expertise to patients nearer to their homes. Physicians have until recently undertaken domiciliary consultations. However, in the past that service was often used as a means of expediting a patient's admission to hospital. The development of medical assessment units in hospitals, which guarantee a specialist assessment of an acutely ill patient within 12 hours, has seen the number of domiciliary consultations requested by general practitioners (GPs) decline dramatically. GP fundholding in the 1990s saw consultants commissioned by GP practices to provide clinics in GP surgeries. This was, however, patchy and fragmented. It was not cost effective, when patients were only drawn from one practice, and disappeared when GP fundholding was abolished. Recently, some groups of GPs through Practice Based Commissioning have commissioned hospital consultants to provide outpatient clinics in their surgeries, serving patients from several practices. Many specialists also provide outpatient services to community hospitals, outside the district general and teaching hospitals.