While reading about commissioning recently my eye was caught by one particular phrase. “Commissioners will be free to buy services from any willing provider” Bearing in mind that secondary care providers will have to be specialists with the relevant qualifications it is initially difficult to see how, in practice, this could mean anything other than the local hospital already providing these services. But think for a moment. “any willing provider”. In theory this could include individual specialists or small consortia of individuals, independent from the local hospital trust. This would not be feasible I admit for many specialities, especially the surgical ones. However there are some specialities where much of the work currently done in the hospital could easily be done, by the specialist, in a primary care setting.
This could have certain advantages. First of all there would be the guarantee of a consultant delivered service. Patients would not be seen by trainees, or nurse specialists but by the consultant, every time. Secondly many of the frustrations afflicting GPs trying to book appointments at the hospital would disappear. No more referral management, or choose & book. You simply book your patient into the next session when the specialist visits. Also there is the convenience to the patients of being seen in their own local surgery, rather than trekking all the way to the hospital, and getting ripped off in parking charges.
There are also other aspects. I have commented before that there is a wedge driven between primary and secondary practitioners. We are isolated from one another, professionally, socially and philosophically. In my area I personally know only two GPs. There is a consequent failure of understanding between us, an “us & them” attitude which can only disadvantage our patients.
If GPs had their own specialists working in the practice they could gain much more than simply specialist care on tap. They would have access to advice for patients who might not justify a formal referral, and more rapid and personal communication. The specialist too would gain valuable information from the GP. Inevitably visiting specialists would share coffee and breaks and a better relationship would develop. The wedge and the isolation would disappear.
I am aware that doctors are by nature a conservative bunch and this idea may seem a bit radical for some. I expect that the idea would be shot down in flames by colleagues in both primary and secondary care.
But I think for some specialities this could work.