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DH must prove commitment to transferring care out of hospitals

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The DH and NHS Commissioning Board have been urged to counter the 'default setting' under which patients are cared for in hospitals and to demonstrate their commitment to transferring work into the community and the home, when it is in the patient's best interests.

In a report published last week, the NHS Confederation said limiting larger hospitals' care to specialist treatment for the acutely ill could significantly improve both patient experience and clinical outcomes, as well as making the NHS more efficient.

It argued the NHS and the public must shift their 'default setting' for delivery of healthcare from hospitals to the community, adding that providers of community services have started transforming care deliver, but urging them to go further.

The news came as the NHS Alliance published a manifesto calling for 'a true primary care-led NHS', in which 'hospitals should be seen as places of last resort for healthcare' and for new structures that 'free clinicians from traditional organisational and professional boundaries'.

Entitled Breaking Boundaries, the document, launched by Alliance chair Dr Michael Dixon at the Healthcare Innovation Expo in London, details 28 proposals. These include support for general practices to investigate ways of working together; better partnerships between primary care and local communities; making community health professionals part of practice teams and linking this with voluntary services; and introducing payment systems to reward primary care for producing health - not just for treating ill health.

The manifesto calls for patients, professionals, managers and policy makers to break the boundaries that disable people from caring for themselves and prevent clinicians from delivering quality, cost-effective, integrated care with a focus on health and wellbeing and prevention. According to the Alliance, such a change is necessary to deliver a sustainable NHS.

Yvonne Sawbridge, a nurse and co-vice chair of the NHS Alliance, told Independent Nurse: 'This manifesto is about "team primary care". I don't think specialists and generalists should be aligned to a primary or secondary care organisation.'

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