UK to move minor operations and tests out of hospitals into GP practices

31 October 2006

As part of a major UK policy change designed to cut hospital stays and reduce costs in the NHS, Health Minister Lord Warner has announced a nationwide wave of demonstration projects. These could pave the way for the NHS to carry out millions more operations and tests at the doctor's surgery instead of in hospitals.

The 30 pilots are testing how teams of consultants, GPs and nurses can safely and effectively provide minor operations, such as varicose vein and hernia repairs; diagnostic tests, including hearing checks; and step-down care closer to patients' homes.

The Department of Health pilots will investigate shifting care from large hospitals to more convenient community settings in six specialty areas — urology, ear, nose and throat, dermatology, orthopaedics, gynaecology and general surgery.

Health Minister Lord Warner said: "We know from our white paper consultation that the majority of people support moving NHS services closer to home. These innovative pilots are a vital step towards providing NHS patients with what they want — the right care, in the right place, performed by the appropriate skilled person. These 30 pilots are all operational now and benefiting patients. What we want to do now is evaluate them, learn from them and see how we can go to scale across the NHS to benefit far more people.

"The rationale behind providing care closer to home is based on the better use of highly specialist skills, not the dilution of them. In some areas, this will involve making sure there are GPs who are as skilled with the scalpel as they are with the stethoscope.

"There are many innovative services already underway - from GPs carrying out operations for lumps and bumps through to home chemotherapy. We will learn from these and we are working with the medical profession and its leaders to ensure that NHS services are both easy to access and of the highest quality."

Clinicians and members of the Care Closer to Home Steering Group also welcomed the pilots. Professor Dame Carol Black, Chairman, Academy of Medical Royal Colleges, said: "I welcome these demonstration projects, which are designed to examine how services in selected specialties can best be delivered closer to where people live, rather than in the hospital setting. The projects represent an important step towards removing outdated barriers that have often separated primary and secondary care.

"It is particularly important that these projects are undergoing careful evaluation to ensure not only that high quality care in the various specialities can be delivered in this way, but that it is also good value for the money invested."

Royal College of General Practitioners Chairman Professor Mayur Lakhani said: "Good general practice is essential in delivering care closer to home. There is an untapped potential for primary care to deliver even more services for patients so we welcome these demonstration sites showing how this much-needed decisive shift can be achieved. The evaluations will help identify factors that support care close to home."

Nigel Edwards, director of policy at the NHS Confederation which represents more than 90% of NHS organisations, said: "The care closer to home agenda is about providing good local, accessible services that meet people's needs. The NHS all too often runs services that force patients to move from place to place to get treated. If we are serious about providing choice and a true voice for patients, we need to be building services around patients in a much more coherent way.

"It is important not to confuse bringing care closer to the patient with tackling deficits. The reorganisation of services and moving more care into the community is not just about efficiency savings, but about ensuring patients are treated in the right place, at the right time by the most appropriate healthcare professional. We must work together to ensure the right services are in place in the community to cope with the extra demand, which is why these pilot projects are so important."

A number of different approaches will be evaluated, including consultant-led clinics provided in community settings, surgery led by specially trained GPs, nurse-led services, dedicated telephone follow-up systems for outpatients and home chemotherapy.

Pilot projects include:

  • Dermatology in Hull: GPs and consultants are working alongside each other in GP surgeries and hospitals and a pharmacist is holding a weekly clinic for wart patients and those diagnosed with eczema and psoriasis.
  • Ear nose and throat services in Surrey: children and their parents are benefitting from a one-stop hearing and ear, nose and throat assessments, ending the need to shuttle children between hospital-based ear, nose and throat clinics and community-based audiology clinics.
  • General surgery in Cornwall: two specially trained GPs at the Probus Surgery are providing minor and intermediate surgery for hernias and carpal tunnel from the practice.
  • Gynaecology in Bradford: a specially trained GP is running a menstrual disorders clinic with a gynaecological nurse specialist. Procedures are undertaken with a consultant present.
  • Orthopaedics in Bolton: patients are offered an alternative to hospital care, with a consultant led team providing a community-based one-stop shop offering expert assessment, tests and treatment.
  • Urology in Newcastle: the Freeman Hospital is running a home chemotherapy service for patients with more straight forward bladder cancer, transferring care traditionally provided in the hospital itself.

The pilots follow the commitment made in the white paper, 'Our Health, Our Care, Our Say', to work with associations, including the Royal Colleges, to define the appropriate models of care. The department is working with the pilots to identify the best approaches that can be rolled-out across the NHS.

The department is working with a steering group, including the heads of Royal College of Surgeons, Royal College of Nursing, Royal College of Physicians and British Medical Association, to identify the most suitable pilot sites. This group, together with patient representatives, will make recommendations to the department early in 2007 about which models are appropriate to adopt nationwide.

There are currently nearly 45 million outpatient appointments every year in England. It is estimated that, for some specialties, up to half of these appointments could eventually be provided in a community setting.

In developing these new models of care, the NHS is accelerating the necessary service transformation which will help deliver a maximum 18 week pathway from referral to treatment by 2008.

Wider plans to offer NHS services closer to where people live and work outlined in January's white paper include a commitment to invest £750 million in the development of community hospitals and community services. This investment aims to deliver speedier access to medical tests, day surgery and even out-of-hours GPs.

You can download the UK government whitepaper from the Department of Health website: Our health, our care, our say: Making it happen (the link is too long to show directly)

You can also download a related document: Our health, our care, our community: investing in the future of community hospitals and services (PDF, 354K) www.dh.gov.uk/assetRoot/04/13/69/32/04136932.pdf

Full list of Care Closer to Home Demonstration Project pilot sites:


  • Middlesbrough Primary Care Skin Service - Middlesbrough PCT
  • Self referral dermatology clinic - University College London Hospital
  • Dermatology dept Princess Royal Hospital, Hull
  • Community dermatology clinics - University Hospitals of Leicester
  • Intermediate Care Facility, Leeds Teaching Hospitals NHS Trust and Leeds North West PCT


  • Bradford Sunny Bank Medical Centre
  • Nurse led clinic Doncaster Gate Hospital
  • Virtual audiology clinic - Ipswich Hospital NHS Trust
  • GPwSIs - Bodmin and Liskeard Community hospitals
  • Paediatric ENT service - Epsom General Hospital

General Surgery

  • Probus Surgery, Cornwall
  • Colorectal cancer telephone follow-up, Royal Hampshire County Hospital
  • Hernia Direct Access Service, Leicester Royal Infirmary
  • Community Nurse Endoscopy Clinic, Newcastle Freeman Hospital
  • Masectomy service - University Hospital Hartlepool


  • GPwSI and nursed led gynae clinic - Bradford Teaching Hospitals NHS Trust
  • Gynae service - Cromer Community Hospital
  • Direct access Emergency Gynaecology Unit, Guys and St Thomas NHS Foundation Trust
  • Community gynae clinic -Newcastle PCT
  • Withington Community Hospital - one stop gynae consultations


  • Multidisciplinary muscular skeletal service - Oldham
  • One stop multipofessional musulo-skeletal service Kingston PCT and Richmond and Twickenham PCT
  • One stop shop for orthopaedics - Bolton PCT
  • Middlesbrough PCT - multidisciplinary musculoskeletal service
  • Eastleigh and Test Valley South and New Forest PCT - multiprofessional triage team


  • Open Access Ultrasound Service, Edgware Community Hospital
  • Home Intravesical Chemotherapy Service, Freeman Hospital
  • GP with Special Interest in Urology, Bradford South and West PCT
  • Primary Care based Testicular Ultrasonography service- Colchester General Hospital
  • Outreach urology service- Nottingham City Hospital Trust

Members of the Care Closer to Home Demonstration Group:

  • Dame Carol Black, Academy of Medical Royal Colleges
  • Anna Walker, Chief Executive, Healthcare Commission
  • Bernie Ribiero, President, Royal College of Surgeons
  • Beverly Malone, General Secretary, Royal College of Nursing
  • Professor Ian Gilmore, President, Royal College of Physicians
  • Dame Gill Morgan, Chief Executive, NHS Confederation
  • Douglas Pattison, Former Chief Executive, Hinchingbrooke NHS Trust
  • Dy Mayur Lakhani, Chairman, Royal College of GPs
  • James Johnson, Chair, British Medical Association
  • John Dixon, Association Directors of Social Services
  • Chris Butler, Hammersmith and Fulham PCT


The Department of Health is funding the overall programme to evaluate and report results on a consistent basis across all the demonstration sites. Funding for the delivery of care itself is provided by practices and PCTs.

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