Responsibility for carrying out routine check-ups of patients six weeks after surgery is to shift from consultants to GPs. The Department of Health estimates that the move will save the NHS in England £1.9bn (€2.8bn; $3.7bn) a year.
The proposal, which will cover elective surgery, has been recommended by David Colin-Thomé, the national clinical director for primary care, in a report that is due to be published later this month. The health department is almost certain to adopt the plan, because it will free up surgeons' time, allowing them to spend more time in theatre. It should also enable more trusts to meet the government's target of a maximum of 18 weeks by the end of 2008 for the time that patients wait for treatment after being referred by their GP.
Dr Colin-Thomé told the BMJ that patients who develop complications such as pain or infections normally do so within six weeks of surgery and would go and see their GP rather than waiting to see a consultant at their routine six week follow-up appointment.
He said, “Many places around the world offer patients advice about when they should see their GP, and when they are given this many require no follow-up at all. In many parts of the country GPs are already making arrangements with surgeons locally about which patients should be followed up. But we are saying [in the report] that this should become a general principle.”
Mayur Lakhani, chairman of the Royal College of General Practitioners, said that if the changes can be set up properly they should benefit doctors as well as patients.
“We should not see this as a tussle between GPs and surgeons but [as] the best outcome for patients and the best use of GPs' and consultants' time,” he said. “We can't get away from the statistics which show that many follow-up appointments are unnecessary. Practice based commissioning could drive this change. But I don't think this should be done in an unmanaged and unsupported way. One way forward would be for surgeons and GPs to agree locally which procedures would be followed up in primary care and for which follow-up is clinically important.”
The NHS in England provides 31.5 million check-up appointments in hospitals every year at a cost of £90 each. Transferring appointments to primary care could cut the cost by two thirds.
A spokesman for the Department of Health said that although most routine check-ups would be provided by GPs under the new plans, there may be instances where patients or surgeons could ask for the consultant to take the appointment.