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The need to invest in training
Patients and their carers are very clear that they want to see healthcare delivered wherever possible at home or in homely settings in the community. Medical advances now mean that we are able to deliver far more healthcare outside acute hospitals and this is a trend that is likely to continue.
Although the number and range of general practitioners with special interests has been disappointing, many family doctors have extended their skills so that they are able to offer services to patients that would previously have been available only from a hospital specialist. However, this should not be seen as an opportunity to provide specialist care on the cheap and special interests must not dilute the discipline of general practice. It is a gem within our National Health Service (NHS) and firmly established as a specialty in its own right.
Today’s medical graduates are far more aware than their predecessors of the importance of healthcare outside teaching hospitals. Hospital specialists generally welcome the prospect of seeing patients in the community and itinerant clinics promote closer working between primary and secondary care. However, specialist care in the community requires premises to operate from and the current programme of community hospital closures seems an odd way to promote it.
Specialty care in the community is unlikely to flourish while postgraduate deans have their training budgets raided to remedy NHS deficits. Disinvesting in training today means a de-skilled and demoralised workforce tomorrow.
So there is great potential to offer more healthcare at home or in homely settings, but the Government needs to make sure its policies keep up with medical advances and with the changing expectations of patients and their carers.