Consultants and other specialist doctors are no longer confined behind the walls of hospitals and acute trusts. More and more are working in primary and community care. Specialisms such as paediatrics, diabetology, elderly care and many others can provide excellent quality care closer to the patient's home.
But this group of doctors are neglected by the system. No-one knows how many there are. No-one is making sure they have the same professional support, clinical governance and training opportunities as their colleagues in acute trusts - or as GPs, for that matter. No-one is looking at how primary and secondary care is properly integrated to ensure the best quality patient care.
Doctors have told the NHS Alliance that specialist medical opinion has been marginalised. Some are concerned that a plethora of community services have been set up without thorough consideration of clinical quality and on "soft foundations". A critical appraisal is needed, they say.
Now the NHS Alliance Specialist Doctors' Network has come up with a solution.
They propose Integrated Provider Organisations within primary care, where specialists, GPs, senior nurses and other health professionals would work closely together across the hospital-community divide.
In a paper published: Specialist doctors in community health services, the Alliance says they would be purpose-oriented rather than just purpose built, and developed along the lines of the polyclinics proposed by Lord Darzi for London. To make sure that they promote effective joint working and focus on patient needs rather than the convenience of the system, a review of primary care commissioning and contracting would be needed. However, they have the potential to provide high quality care, and to manage patient and provider led demand, improving the cost effectiveness of the health services they provide.
Dr Minoo Irani, a consultant paediatrician who works in Berkshire and the NHS Alliance national lead for specialists in primary care, said:
"A great deal has been achieved by the innovation of individual clinicians, both specialists and GPs. But we cannot continue to rely on that, nor continue to neglect the professional needs of consultants and specialists working in community health services. We have to develop a system that properly supports clinical quality and safety."
NHS Alliance chairman Dr Michael Dixon agrees. He said:
"What these consultants and specialists are telling us cannot be ignored. All is not well and we need to look carefully at how care closer to home is developed. But as always, the NHS Alliance has a solution to current problems. Integrated provider organisations have the potential to benefit everyone - patients, clinicians and the tax payer."
1. The NHS Alliance is the independent body that represents primary care. Its membership includes PCTs, GP practices and other primary care organisations, alongside individual clinicians, managers and non-executives. Its multi-professional base means it is the only organisation that can bring PCTs and practices together. It has active special interest networks for practice based commissioners, PEC chairs. PCT chief executives, non-executives, primary care providers and more.
2. The NHS Alliance Specialists Network is one of twelve NHS Alliance networks. Their report is underpinned by annual workshops, a recent survey of members and numerous exchanges of experiences and innovations. Input from the Network' steering group has been vital. The group includes consultants and other specialist doctors in all the main specialities currently working in primary care, including: audiovestibular medicine, diabetology, gastroenterology, gynaecology, ophthalmology, paediatrics and urology.