Dr Nat Wright: "ah ha. who's the gatekeeper - well that's another post for more discussion in its own right....."

I think you're right Nat.
And that's a good point Tony.

I think this is something that is going to depend on the relative strength/interest/maturity of primary and secondary care in any locality.

Where there is a cadre of GPs with that confidence/competence, or unusually (the Wirral used to be mentioned about its alleged 100% GP involvement)where that c/c is pretty widespread across practices, then I guess there is the potential to frame it in that way.

It's going to depend on the appettite for that configuration of the refrral and care pathways by the leading local GPs/commissioners.

Cheers
Simon

My experience of working in 2 DATs and a SMAT (Cardiff)is that the vast majority of people commence treatment in secondary care and then move out to primary care (unlike the rest of the healthcare system)with only a small handful of exceptions. While there will be sound clinical reasons for this is some cases I'm not convinced it applies in the majority of cases. This is something we will be looking at locally as part of a treatment system redesign where one of the key drivers is about more local delivery of treatment services.
It was a policy of Cardiff City Council that wherever someone first contacted the council, that was the right point of contact and it was the employees responsibiltiy to signpost the person on to the appropriate place-so if somebody's first point of contact with the treatmenet system is in primary care-initial assessments etc. could/should be done there and the person quickly transferred to specialist services if needed. I think it also throws up other issues-care pathways as you say-but also thresholds/eligibility criteria and how these are measured (Christo?) so that there are clear, consistent criteria for people movong from secondary care into primary care, and back again if necessary-it would be interesting how this works (or doesn't work) in other areas.

PS-I've had to re-register on the forum with my new email address (having changed jobs 2 weeks ago)-as there is already a "tony mercer" registered on the forum, I now appear as mercer,tony. Could the moderator delete "tony mercer" with the wolverhampton email address?