A recent report from The King’s Fund has found that specialist knowledge is too concentrated in hospitals, to the detriment of those patients whose increasingly complex needs should be treated closer to home.
Over the past 20 years, both the volume of patients and the complexity of cases requiring treatment in the community have increased.1 Demographic changes, technological advances and the changing pattern of disease have driven this growth, as has the transfer of the care of whole groups of patients to primary and community settings – such as those previously cared for on long-stay geriatric wards.
However, there has been no commensurate shift of resources and expertise to the community. This has resulted in many patients receiving fragmented care, with different parts of the system often failing to communicate effectively with each other. Patients can miss out on care or wait weeks for an appointment at their local hospital for diagnosis or treatment that could be completed in a primary or community care setting if the necessary skills and resources were available to do so.2
The ‘Specialists in out-of-hospital settings’ report combines research with case study material, to identify new ways to deliver care outside the hospital. It has identified a requirement to develop new roles for hospital consultants who the authors believe should spend more time working outside hospitals in multidisciplinary teams with primary, community and social care colleagues.
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