Specialists working in out-of-hospital settings

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Read the final report

As part of a project looking at new models of service provision, The King’s Fund visited six services in which consultants were delivering or facilitating care outside of the traditional hospital setting. Our report presents the findings from those visits as case studies. It identifies key characteristics and challenges to this way of working and seeks out evidence of the benefits to patients and the NHS more broadly.

Read the report: Specialists in out-of-hospital settings

What did we do in this project?

The research looked at a set of six case studies, based on services in six different hospital specialties. Through interviews with those involved in developing and delivering these services the project aimed to:

  • describe the aims and objectives of each initiative; arrangements for funding and commissioning, workforce, training and education, and clinical governance; and the required management and culture change
  • explore the barriers and enablers to implementation at the local and national level, drawing out key themes and lessons
  • seek examples of meaningful impact measures and, where possible, provide evidence on impact.

Why were we interested in this project?

There is growing interest in new models of service provision in which specialist care is delivered outside of traditional hospital settings. In October 2013, The King’s Fund held a roundtable event at which consultants from a range of specialties spoke about services they had set up in their local communities, and the challenges and lessons associated with their implementation.

This new way of working is a key element of the Royal College of Physicians' vision for the future hospital. They call for radical changes to the way hospitals are structured, and recommend that medical teams bridge hospital and community settings, working with community, primary and social care colleagues to provide a co-ordinated seven-day service, close to patients’ homes.

Findings from our research will be of interest to clinicians and managers seeking to set up similar services in their local health economies, and to national stakeholders seeking to understand the impact of national policy levers on this type of service development.

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