Health Services Delivery Research 2016;4(15)
- This study updates a 2006 literature review on ways of improving the effectiveness and efficiency of hospital outpatient services.
- A new review of the current literature on the subject and found that, with appropriate safeguards and support, substantial areas of care traditionally given in hospitals can be transferred to primary care. For example, relocating specialists to work in the community is popular with patients, and joint working between specialists and general practitioners (GPs) can be of substantial educational value.
- A number of substudies based on interviews were also carried out into five areas:
- management centres (organisations established to review referrals and potentially divert them away from hospitals),
- in-house review of referrals by GPs,
- financial incentives to reduce referrals,
- consultants contracted to community organisations and
- international experiences of moving care from hospital into the community.
- The study concluded that:
- High-quality care in the community can be provided for many conditions and is popular with patients.
- It may not be cheaper to move care into the community, and more evidence is required on cost-effectiveness.
- Moves towards care in the community can be justified if high value is given to patient convenience in relation to NHS costs or if community care can be provided in a way that reduces overall health-care costs.
