Patients with a wider range of conditions can expect reduced waiting times and shorter journeys as the NHS moves treatment for more conditions away from hospitals and into Primary Care Trusts. Some specialties such as ear, nose and throat are already carried out in local surgeries and annually some 600,000 treatments are now carried out locally.Shifting healthcare away from hospitals will involve nurses taking on work in areas such as heart failure, diabetes, stroke care and falls prevention. General Practitioners will take on work related to child protection, drug misuse, emergency care, epilepsy, headaches, mental health, palliative care and respiratory disease.

New guidance issued by the Department of Health recognises that GPs and nurses have developed skills in some specialties that can be used effectively outside the hospital. There are already nurses with special interests and the guidance aims to build on this good practice.

Primary Care Trusts will be free to commission appropriate enhanced services to meet local health needs and GPs and nurses with special interests will have a head start in the provision of these services under the new contract. This wider range of work will boost their incomes.

The Department of Health quotes an example of moving treatment locally where a GP in Oxfordshire treats patients for ear, nose and throat conditions who are referred to him by GPs in the area. He sees 15 to 20 patients a week during normal practice. Patients wait on average just 24 days for a consultation and 61 per cent of referrals can be discharged without reference to a hospital. 97 per cent of patients felt confident in seeing a GP with a special interest in the place of a consultant.