TY - JOUR T1 - Editorial comment: Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England JF - Future Hospital Journal JO - Future Hosp J SP - 180 LP - 181 DO - 10.7861/futurehosp.2-3-180 VL - 2 IS - 3 AU - Adam Gordon Y1 - 2015/10/01 UR - http://www.rcpjournals.org/content/2/3/180.abstract N2 - Recent UK health policy statements have placed increased emphasis upon care delivered closer to home.1 In this context, an increasing number of service and contract specifications for specialist physicians to work in the community have been established.The movement of secondary and tertiary level expertise into the community has, for geriatricians at least, long been a source of considerable angst. Much of this soul searching has focused around the assertion that translocating geriatricians from hospital-based clinics and wards is of unproven benefit and comes with some opportunity cost. Geriatricians employed in the care home sector, or in doing domiciliary visits, will not be available to support orthogeriatric ward rounds or ward-based rehabilitation, each of which has more evidence for improving clinical outcomes than community geriatrics. Fourteen years after fractious and, at times, undignified debate about this exploded onto the pages of the BMJ,2,3 we are no closer to understanding the comparable efficacy, or cost effectiveness, of what a geriatrician can deliver in the community, versus what they can do if employed elsewhere. This is, in part at least, a consequence of the fact that understanding the clinical impact of a single specialist physician as a contributor to complex health and social care systems confounds traditional evaluative methodologies.Other specialties … ER -