In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are delivered closer to the community and by their general practitioner. However, it is unclear if moving services to the community tends to be more or less cost-effective; costs may be a problem when specialist are moved from hospital to primary care to deliver a service in an ambulatory setting, so it is a way of moving services that should be generally avoided.

The author concludes that  shifting healthcare from hospitals to the community will only be justified if patient satisfaction and convenience is valued above costs to the NHS, or if this shift reduces healthcare costs in the long term.