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Developing an evidence base for intermediate care delivered by GPs with a special interest.

Year: 2005
Type: article
Abstract: Although the delivery of specialised skills from GPs is not new, the NHS Plan formalised the role of the GP with a special interest (GPwSI) as part of a radical programme to reconfigure the healthcare workforce.1 This development was part of a broader policy agenda to shift the balance of care towards the primary care sector, in order to deliver more patient-centred services and reduce waiting times and avoidable admissions to secondary care. However, against a background of increasing demands on limited resources and the need to maximise the benefits of additional health service investment, the focus has shifted to cost-effectiveness.2 Building on these developments, national frameworks were developed to define skills, competencies and governance but primary care organisations were encouraged to develop innovations in service delivery based on local need.3 However, despite the policy rhetoric, the initiative has developed considerable momentum without any evidence base. The randomised controlled trial by Baker et al 4 in this month's Journal (page 912) showing no differences in clinical outcomes between orthopaedic hospital and practice-based clinics reflects an early and developing evidence base of the effectiveness of GPwSIs. With the shift in emphasis to decision making at a local level, a key question is how the evidence base can be developed to support policy decisions in a way that is relevant to local health economies. The evaluation of public policy is set across a spectrum of approaches. The dominant analytical framework for health policy research reflected in Baker et al 's study is known as a rational approach. In its broadest …
Institution: University of York
Language: English
Open Access status: green
OpenAlex ID: W192950638
FWCI: 2.44
Cites: 9
Cited by: 12
Related to: 10