Intended for healthcare professionals

Feature New Models of Care

Hierarchy disruptors: bringing specialist knowledge from hospital to community care

BMJ 2019; 365 doi: (Published 28 June 2019) Cite this as: BMJ 2019;365:l4376
  1. Lynn Eaton, freelance journalist
  1. London
  1. lynn{at}

A US model to facilitate learning among community and specialist clinicians has spread worldwide and been used by Hospice UK. Could Project ECHO transform the NHS, asks Lynn Eaton

Imagine comprehensive community based healthcare, where more patients can receive specialist advice locally, without having to go to a hospital. Where ongoing training enables generalists to develop specialist skills. And which routinely enables hospital consultants to share their knowledge with, as well as learn from, clinicians on the ground.

Such an approach is being piloted around the world. If it works, its proponents claim it could provide a new model of care for the whole NHS. There are already 60 examples of its use in UK care, particularly in community palliative care.

The model, Project ECHO (extension for community healthcare outcomes), uses virtual meetings to share knowledge from the hospital environment with clinicians closer to patients who can’t easily reach a specialist, hopefully improving their care. Video conferencing enables training among specialist and community based clinicians who can learn from each other simultaneously.

Project ECHO was developed by the University of New Mexico Health Sciences Center, which has patented it. The non-profit venture is backed by the US government and private donors.1

So many patients, so little time

In 2003 Project ECHO’s founder, Sanjeev Arora, a hepatologist based in Albuquerque, was frustrated that he could treat so few of the 28 000 patients with hepatitis C in New Mexico. “I was seeing people dying of liver failure. People were waiting eight months for an appointment and then driving hundreds of miles each way, making 12 trips to see me,” he told The BMJ. “These were poor people. They just didn’t have the resources to make those journeys.”

He decided to share his knowledge with practitioners closer to …

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