NHS consultants can and should do more work in out-of-hospital settings, says a report from The King's Fund.
The report, Specialists in out-of-hospital settings: findings from six case studies, examined six case studies where consultants have worked outside hospitals, such as by allowing patients with complex needs to be treated at home and intermediate services which provide specialist care which cannot be provided by GPs.
The case studies were chosen as examples of being more than the "drag and drop" approach which moves an outpatient clinic beyond a hospital.
The report also highlighted the need for specialists, with between 40% and 50% of GPs having had little or no paediatric training, when childhood illnesses make up two-fifths of their workload.
The report notes that GPs also deal with 13 million dermatology consultations each year, but their training involves just six days of dermatology teaching and there are no dermatology attachments available on most GP training schemes.
Education was highlighted in the report as a key need for doctors to improve the availability of specialist care, along with access to consultants to improve diagnosis and treatment.
The NHS' funding scheme was highlighted as a potential barrier to change as the current system does not encourage hospitals to support care outside their clinics.
The report also noted that transition funding would be needed to support changes. Better data on the financial implications of how hospitals provide services on the rest of the health system was also highlighted as a need.
Dr Paul Flynn, chair of the BMA Consultant Committee said:"Consultants are open to different ways of working to deliver more patient-centred care, and many already work in the community alongside GPs and other healthcare professionals in areas such as public health, mental health and paediatrics.
"With the existing system under extreme pressure, and consultants as well as GPs struggling to meet rising demand, it is not clear how significant numbers of consultants could be moved out of hospitals without leaving some services dangerously understaffed. This points to a need for greater investment rather than assuming that delivering specialist care outside hospitals is a cost saving measure."
