The Royal College of Physicians has warned that almost half of doctors are unclear about their role in the government’s plans for neighbourhood health.
The Royal College of Physicians (RCP) is seeking urgent clarity on how medical specialists will work within neighbourhood care settings, noting that around half of them are currently unsure.
In its RCP View on neighbourhood health report earlier this month, the College claim 48% of respondents report being unclear about how their role would play out within a neighbourhood health team.
The Neighbourhood Health Service was laid out in NHS England’s 10 Year Health Plan. Published in July last year, this shared plans to “bring care into local communities, convene professionals into patient-centred teams and end fragmentation”. The RCP, however, feels patients still risk this continued fragmentation between services and professionals without greater clarity.
10 Year Health Plan
The plan also revealed a commitment to reform outpatient care, now known as ‘planned specialist’ care.
The RCP has welcomed this, but as the neighbourhood health rollout is underway, is keen for greater understanding on the role of medical specialists, in fields such as cardiology, gastroenterology, geriatrics and respiratory.
According to the RCP, this must be defined if neighbourhood models and neighbourhood planned specialist care are to deliver more effective, timely care where patients benefit from the expertise of specialist doctors best equipped for their care.
It also used this year’s member snapshot survey of physicians in England to ask 417 respondents about how they feel delivering neighbourhood health would affect their day-to-day clinical workloads. A total of 42% expressed worries about this element.
Their top concerns included increased workload without protected time in job plans, unclear clinical responsibility, accountability or escalation routes for complex patients and reduced time for specialist inpatient or outpatient work.
They are also keen to keep burnout at bay and avoid as much reliance on virtual or remote consultations.
Revising definitions
The RCP feels successful neighbourhood working will require a reshaping of how specialists work across the system. It would like to see particular changes to workforce planning, education and training, and digital infrastructure to enable doctors to work across traditional siloed boundaries.
Hilary Williams, clinical vice president of the RCP, said: “We know from talking to our members up and down England that physicians are excited about the opportunities of neighbourhood health, but nearly half are unclear about their future role. Healthcare is getting more complicated, and with rising multimorbidity and rapidly expanding treatment options for everything from COPD to cancer, the role of expert physicians working with communities has never been more important.
She continued: “Neighbourhood working offers significant potential to deliver the reformed approach to planned specialist care that the RCP has long advocated for, but it will only be successful if it brings together the professionals that patients need for safe and effective care – medical specialists alongside primary and community expertise.”
The report also makes a series of recommendations for the government, NHS England and local systems. These include that Integrated Care Boards work with doctors to define the role of medical specialists in their neighbourhood approach to planned care, and clear principles for a multimorbidity planned care pathway for adults who aren’t older or frail.
