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Reconfiguring health services to provide care closer to home
  1. Mayur Lakhani
  1. Correspondence to:
 Royal College of General Practitioner
 14 Princes Gate, Hyde Park, London SW7 IPU, UK; mlakhani{at}

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Specialists and generalists working together in the community for the benefit of patients

As a practicing general practitioner, I am well aware of the fragmentation and disruption that patients have as they traverse the health and social care journey. I also realise that patients need a combination of generalism and specialism in the community. Currently, services are organised around the convenience of organisations and professionals rather than the clinical needs of patients. For example, community nurses may provide services according to who their employer is rather than the clinical need of the patient, although they are all members of the National Health Service (NHS) family.

Health service policy in England promotes “care closer to home”,1 reconfiguration of services and an ambitious 18-week target from referral by a general practitioner to completion of treatment by 2009. The new policies pose a formidable implementation challenge for local health communities and will require new ways of working and better models of care. Most importantly it will need to be underpinned by a sound education and training strategy. Support will also be required to develop other skills—in leadership, teamwork and information communication technology.

In all these endeavours leadership from professional organisations and doctors will be essential. In 2006, the Royal College of General …

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