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International Primary Care Association

Clinical Focus Volume 1 N1

Volume 1 Issue 1 - 2005


This article is a management review of the challenges facing Primary Care Trusts with the introduction of Choice at point of referral in December 2005. Practitioners with Special Interests could be key to developing robust primary care services. They have unique skills in primary care and in their specialist area which could be utilised to develop locally provided services with rapid access that prevent hospital appointments. If a hospital appointment is required, they are excellently placed to provide expert information to patients concerning their choices, ensuring that the choice offered is clinically appropriate for that patient. Accurate data on referral levels in all specialties is essential to ensure the correct level of capacity is purchased by PCTs with appropriate secondary care providers. This article recommends the use of a Referral Monitoring Centre to assess the capacity needs now, to provide accurate data collection.

Over the last few months there have been significant changes to the expectations and requirements for General Practitioners in several areas of their practice. In particular, the New GMS Contract aims at increasing the quality of care and is measured with quality markers. If the quality markers are achieved, GPs are awarded points, which are then translated into increased practice profit. However, it is all too easy to fall into the trap of fulfilling the criteria without drawing any conclusions or acting upon them.


This study reviews how primary care trusts (PCTs) are supporting redesign of care pathways from primary care into consultant outpatient services Footnote 1. Its aim is to help PCT managers understand:

  • Which organisational and contextual factors have particular impact on a PCT’s ability to progress successful redesign programmes
  • How some PCTs have overcome local barriers to implement new care pathways.

Redesign helps to ensure that patients are treated by the most appropriate healthcare professional in the most appropriate location. This improves patients’ experiences (for example, by reducing waiting times), helps to manage demand for acute care and introduces a greater range of providers,


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