Developing intermediate care provided by general practitioners with a special interest: the economic perspective.

The concept of intermediate care is part of the National Health Service (NHS) modernization agenda to make services more flexible and accessible. One objective is for the general practitioner with a special interest (GPwSI) to provide a variety of extended services in a primary care setting that have been traditionally provided in secondary care. This development is underpinned by the hope that primary care organisations (PCOs) will provide more effective and efficient care in local settings, but, as with other skill-mix changes, the process has developed ahead of an evidence base of effectiveness or cost-effectiveness. This paper considers intermediate care from an economic perspective and provides healthcare commissioners with a background that can facilitate resource allocation decisions. It cautions that, unless the economic issues are carefully considered, there is a danger that services may be introduced that are thought to be efficient, when in fact they may not be so.