Bringing gastroenterology into the neighbourhood
I’ve been thinking about where specialist care needs to sit. Not every gut problem needs a hospital appointment. Some do. But plenty sit stuck in the middle — too complex for a routine GP review, not clear-cut enough to justify a long outpatient wait. That’s the gap a community gastroenterology service could fill.
The idea is simple: put a GP with an extended role in gastroenterology (a GPwER) at the centre of a community team — an IBD nurse, a dietitian, a pharmacist, a virtual line to a consultant. Add local diagnostics — calprotectin, bloods, community ultrasound, a fast route into a Community Diagnostic Centre (CDC) — so that group can be seen, tested and managed without a hospital corridor in sight. It’s where the NHS neighbourhood model is heading anyway — care built around a population, not a building.
What sells me on this isn’t the structure, though. It’s what it does when a diagnosis isn’t clear.
Take a patient with real diagnostic uncertainty. David is 61, with six months of loose stools and bloating. His GP’s done all the sensible things — bloods, coeliac screen, calprotectin, FIT — all clear. Standard IBS treatment hasn’t touched his symptoms. The GP’s running out of ideas. A negative FIT reassures on cancer, normal calprotectin makes IBD unlikely, but neither rules out microscopic colitis or bile acid diarrhoea, both of which can hide behind normal results.
Normally, the GP would consider a consultant discussion or a non-urgent hospital referral. Either route likely means a long wait for a diagnostic test or an outpatient appointment, while David and his GP cycle through treatments that aren’t working.
In the community model that I am proposing, the GP sends that advice and guidance request to the community hub instead of the hospital. The GPwER, having received additional training in gastroenterology, can create a structured approach to this diagnostic scenario. They can arrange the colonoscopy via the local CDC in weeks rather than months, and when the result comes back showing microscopic colitis, initiate treatment and stabilise the symptoms before stepping David down to his GP with a clear plan.
And if there is ongoing concern, or diagnostic uncertainty? The patient can be discussed by the community multi-disciplinary team and a plan formulated, or they can be escalated to the hospital if required.
This is where the real value lies. The community service can act on its own advice instead of providing a recommendation for a busy GP to carry out or placing the patient in a lengthy queue for a diagnostic test without the wrap-around support needed to interpret and act on the result (and escalate when appropriate). It can also protect specialist gastroenterology services for the cases that truly need specialist input – those with complex gastrointestinal conditions, more severe IBD, and those with suspected cancer – thereby improving access to these services for those where it will make the most impact.
The community service arranges the test, reviews the result, adjusts the plan, co-ordinates the multidisciplinary team, and stays involved through treatment rather than answering once and stepping back. That ongoing, team-based follow-up is what creates truly comprehensive and individualised care.
Done well, a community gastroenterology service acts as a valuable interface between primary and secondary care that neither a referral letter nor an advice and guidance reply can be on its own. It lets the GPwERs, nurses, dietitians and consultants involved stay with a patient for as long as it takes to get things right. And that, more than any efficiency saving, is the point.
Dr Charlie Andrews
