Care closer to home: past mistakes, future opportunities.

Abstract

The Government White Paper on improving community health and care services (Our Health, Our Care, Our Say) proposes shifting care within particular specialties from hospital into community settings. The intention is to provide seamless care for patients when and where they want it, in more local and convenient settings. Professionals in primary and secondary care will need to respond by developing new ways of working to enable this policy to be effective. In this paper, we discuss the evidence of the effect of initiatives during previous health care reconfigurations to shift the balance of power from secondary to primary care. We also suggest a partnership model for primary and secondary care clinicians and discuss the potential advantages of working practices across the primary-secondary care divide. Summary Shifting care within particular specialties into community settings is emphasized in the Government's recent White Paper; Two innovations in recent years involving the primary-secondary health care interface have been specialist outreach clinics and general practitioners (GPs) with specialist interests; Both models demonstrate increased levels of patient satisfaction, but may not be cost-effective; It is essential that mistakes of the past are not repeated, but opportunities for better integration of primary and secondary care are not missed.