Specialist practice in the community: chest medicine.

The impact of long term conditions (LTCs) is an issue for all health care systems in the world today. With an aging population and the incidence of LTCs subsequently increasing, the impact on health economics is a challenging burden on all societies. Thus, delivering cost effective high quality care for all LTCs is a major challenge to both health payers and providers alike. This review discusses the various models of care adopted in health systems. It then focuses on community specialist services for respiratory disease in the context of this changing health environment and concentrates on the scope and evidence to support specialist respiratory community services. The review concludes with discussions surrounding the implementation of such services across two large primary care trusts in the UK, with particular focus on the arguments for their future development and incorporation with strategies that are cost effective, while helping older people with LTCs to maintain their health, functional ability and quality of care.