Clin Med
-
The traditional model of acute medical care involves the admission of patients to hospital to be assessed by a consultant and facilitate access to investigation and treatment. This model has, however, led to a number of problems. Firstly, there is high bed occupancy which restricts access and increases the risk of healthcare-acquired infection. ⋯ Thirdly, patients often receive care from a 'generalist' rather than a 'specialist' although there is increasing evidence that the most appropriate specialist provides the best patient care. Many medical emergencies could be managed in the outpatient (ambulatory) setting if the appropriate facilities were available including staff, environment and access to investigations. Emergency outpatient clinics can provide gold standard emergency care by providing structure to the acute take, ensuring access to the most appropriate specialist and training opportunities for junior medical staff.
-
General practitioner (GP) practice-based commissioning (PBC) is a much debated politically driven NHS innovation at a time of ongoing change. Unlike GP fundholding it is envisaged that PBC will involve all GP practices by 2008. A possible outcome is that some current secondary care services may be commissioned in primary care in the form of local enhanced services or intermediate clinics and run by GPs with special interests. ⋯ Similarly, private providers may be commissioned. Inevitably there will be an impact on hospital services through a possible reduction in funding and consultants being subcontracted to provide services in primary care. Issues such as clinical governance and cost-effectiveness, however, require evaluation to determine the potential effect on the working relationships and so the interface between generalists and specialists.