UK to move minor operations and tests out of hospitals into GP practices
31 October 2006
As part of a major UK policy change designed to cut
hospital stays and reduce costs in the NHS, Health Minister Lord Warner has
announced a nationwide wave of demonstration projects. These could pave the
way for the NHS to carry out millions more operations and tests at the
doctor's surgery instead of in hospitals.
The 30 pilots are testing how
teams of consultants, GPs and nurses can safely and effectively provide
minor operations, such as varicose vein and hernia repairs; diagnostic
tests, including hearing checks; and step-down care closer to patients'
The Department of Health pilots will investigate shifting care from
large hospitals to more convenient community settings in six specialty areas
— urology, ear, nose and throat, dermatology, orthopaedics, gynaecology and
Health Minister Lord Warner said: "We know from our white
paper consultation that the majority of people support moving NHS services
closer to home. These innovative pilots are a vital step towards providing
NHS patients with what they want — the right care, in the right place,
performed by the appropriate skilled person. These 30 pilots are all
operational now and benefiting patients. What we want to do now is evaluate
them, learn from them and see how we can go to scale across the NHS to
benefit far more people.
"The rationale behind providing care closer to
home is based on the better use of highly specialist skills, not the
dilution of them. In some areas, this will involve making sure there are GPs
who are as skilled with the scalpel as they are with the stethoscope.
"There are many innovative services already underway - from GPs carrying out
operations for lumps and bumps through to home chemotherapy. We will learn
from these and we are working with the medical profession and its leaders to
ensure that NHS services are both easy to access and of the highest
Clinicians and members of the Care Closer to Home Steering Group also
welcomed the pilots. Professor Dame Carol Black, Chairman, Academy of
Medical Royal Colleges, said: "I welcome these demonstration projects, which
are designed to examine how services in selected specialties can best be
delivered closer to where people live, rather than in the hospital setting.
The projects represent an important step towards removing outdated barriers
that have often separated primary and secondary care.
"It is particularly important that these projects are undergoing careful
evaluation to ensure not only that high quality care in the various
specialities can be delivered in this way, but that it is also good value
for the money invested."
Royal College of General Practitioners Chairman Professor Mayur Lakhani
said: "Good general practice is essential in delivering care closer to home.
There is an untapped potential for primary care to deliver even more
services for patients so we welcome these demonstration sites showing how
this much-needed decisive shift can be achieved. The evaluations will help
identify factors that support care close to home."
Nigel Edwards, director of policy at the NHS Confederation which represents
more than 90% of NHS organisations, said: "The care closer to home agenda is
about providing good local, accessible services that meet people's needs.
The NHS all too often runs services that force patients to move from place
to place to get treated. If we are serious about providing choice and a true
voice for patients, we need to be building services around patients in a
much more coherent way.
"It is important not to confuse bringing care
closer to the patient with tackling deficits. The reorganisation of services
and moving more care into the community is not just about efficiency
savings, but about ensuring patients are treated in the right place, at the
right time by the most appropriate healthcare professional. We must work
together to ensure the right services are in place in the community to cope
with the extra demand, which is why these pilot projects are so important."
A number of different approaches will be evaluated, including consultant-led
clinics provided in community settings, surgery led by specially trained
GPs, nurse-led services, dedicated telephone follow-up systems for
outpatients and home chemotherapy.
Pilot projects include:
- Dermatology in Hull: GPs and consultants are working alongside each
other in GP surgeries and hospitals and a pharmacist is holding a weekly
clinic for wart patients and those diagnosed with eczema and psoriasis.
- Ear nose and throat services in Surrey: children and their parents
are benefitting from a one-stop hearing and ear, nose and throat
assessments, ending the need to shuttle children between hospital-based
ear, nose and throat clinics and community-based audiology clinics.
- General surgery in Cornwall: two specially trained GPs at the Probus
Surgery are providing minor and intermediate surgery for hernias and
carpal tunnel from the practice.
- Gynaecology in Bradford: a specially trained GP is running a
menstrual disorders clinic with a gynaecological nurse specialist.
Procedures are undertaken with a consultant present.
- Orthopaedics in Bolton: patients are offered an alternative to
hospital care, with a consultant led team providing a community-based
one-stop shop offering expert assessment, tests and treatment.
- Urology in Newcastle: the Freeman Hospital is running a home
chemotherapy service for patients with more straight forward bladder
cancer, transferring care traditionally provided in the hospital itself.
The pilots follow the commitment made in the white paper, 'Our Health,
Our Care, Our Say', to work with associations, including the Royal Colleges,
to define the appropriate models of care. The department is working with the
pilots to identify the best approaches that can be rolled-out across the
The department is working with a steering group, including the heads of
Royal College of Surgeons, Royal College of Nursing, Royal College of
Physicians and British Medical Association, to identify the most suitable
pilot sites. This group, together with patient representatives, will make
recommendations to the department early in 2007 about which models are
appropriate to adopt nationwide.
There are currently nearly 45 million
outpatient appointments every year in England. It is estimated that, for
some specialties, up to half of these appointments could eventually be
provided in a community setting.
In developing these new models of care,
the NHS is accelerating the necessary service transformation which will help
deliver a maximum 18 week pathway from referral to treatment by 2008.
Wider plans to offer NHS services closer to where people live and work
outlined in January's white paper include a commitment to invest £750
million in the development of community hospitals and community services.
This investment aims to deliver speedier access to medical tests, day
surgery and even out-of-hours GPs.
You can download the UK government whitepaper from the Department of Health
Our health, our care, our say: Making it happen
(the link is too long to show directly)
You can also download a related document: Our health, our care, our
community: investing in the future of community hospitals and services (PDF,
Full list of Care Closer to Home Demonstration Project pilot sites:
- Middlesbrough Primary Care Skin Service - Middlesbrough PCT
- Self referral dermatology clinic - University College London
- Dermatology dept Princess Royal Hospital, Hull
- Community dermatology clinics - University Hospitals of Leicester
- Intermediate Care Facility, Leeds Teaching Hospitals NHS Trust and
Leeds North West PCT
- Bradford Sunny Bank Medical Centre
- Nurse led clinic Doncaster Gate Hospital
- Virtual audiology clinic - Ipswich Hospital NHS Trust
- GPwSIs - Bodmin and Liskeard Community hospitals
- Paediatric ENT service - Epsom General Hospital
- Probus Surgery, Cornwall
- Colorectal cancer telephone follow-up, Royal Hampshire County
- Hernia Direct Access Service, Leicester Royal Infirmary
- Community Nurse Endoscopy Clinic, Newcastle Freeman Hospital
- Masectomy service - University Hospital Hartlepool
- GPwSI and nursed led gynae clinic - Bradford Teaching Hospitals NHS
- Gynae service - Cromer Community Hospital
- Direct access Emergency Gynaecology Unit, Guys and St Thomas NHS
- Community gynae clinic -Newcastle PCT
- Withington Community Hospital - one stop gynae consultations
- Multidisciplinary muscular skeletal service - Oldham
- One stop multipofessional musulo-skeletal service Kingston PCT and
Richmond and Twickenham PCT
- One stop shop for orthopaedics - Bolton PCT
- Middlesbrough PCT - multidisciplinary musculoskeletal service
- Eastleigh and Test Valley South and New Forest PCT -
multiprofessional triage team
- Open Access Ultrasound Service, Edgware Community Hospital
- Home Intravesical Chemotherapy Service, Freeman Hospital
- GP with Special Interest in Urology, Bradford South and West PCT
- Primary Care based Testicular Ultrasonography service- Colchester
- Outreach urology service- Nottingham City Hospital Trust
Members of the Care Closer to Home Demonstration Group:
- Dame Carol Black, Academy of Medical Royal Colleges
- Anna Walker, Chief Executive, Healthcare Commission
- Bernie Ribiero, President, Royal College of Surgeons
- Beverly Malone, General Secretary, Royal College of Nursing
- Professor Ian Gilmore, President, Royal College of Physicians
- Dame Gill Morgan, Chief Executive, NHS Confederation
- Douglas Pattison, Former Chief Executive, Hinchingbrooke NHS Trust
- Dy Mayur Lakhani, Chairman, Royal College of GPs
- James Johnson, Chair, British Medical Association
- John Dixon, Association Directors of Social Services
- Chris Butler, Hammersmith and Fulham PCT
The Department of Health is funding the overall programme to evaluate and
report results on a consistent basis across all the demonstration sites.
Funding for the delivery of care itself is provided by practices and PCTs.