BMJ  2005;330:651-653 (19 March), doi:10.1136/bmj.330.7492.651

Education and debate

Role of specialists in common chronic diseases

¹ National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9DL Linda Gask linda.gask@manchester.ac.uk

Consultant care is currently available to only a small proportion of people with chronic illness. How can we enable many more people to benefit from specialist expertise?

The first 150 words of the full text of this article appear below.

Introduction

Most people with chronic conditions such as diabetes, congestive heart failure, asthma, and depression are managed in primary care. NHS consultants have traditionally confined their role to patients who are referred to outpatient clinics by their general practitioners. Such patients usually have the most severe and complex problems. Effective care teams for chronic illness must be able to cross practice or organisational boundaries,¹ but the current organisational structure of the NHS does not provide many incentives to develop such linkages. General practitioners refer patients they cannot manage and hospitals are funded on the basis of referrals. Time spent on joint work with primary care is not accounted for. To ensure that all patients get the best treatment, the role of consultants needs to change so that their specialist knowledge is more available to everyone dealing with chronic disease.

Changing roles

In recent years nurses in the NHS have taken on a larger . . . [Full text of this article]

Population perspective

Designing stepped care pathways

New role

Conclusions

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