A damming report has criticised primary care trust management of specialist doctors working in the community.
Specialists employed directly by PCTs feel professionally isolated and that their needs are 'ignored', the NHS Alliance has warned.
Its report, Specialist Doctors in Community Health Services, says: 'Too often, their difficulties have been viewed as: "a problem of their own creation" or "the problems faced by a small number of doctors who should have stuck around in hospitals".'
It calls for the situation to be urgently addressed if care is to be moved closer to home and attract high quality medical and surgical specialists.
This would be achieved by the creation of 'integrated provider organisations' to bring together clinicians from primary and secondary care.
The report says: 'The professional and service delivery challenges faced by the current specialists in PCT employment hardly serves as an exemplar for hospital based colleagues to consider the move to primary care in the immediate future.'
Report author and NHS Alliance specialist network lead Dr Minoo Irani said he was surprised by the scale of the problems reported.
Much of this stemmed from a lack of guidance for doctors coming out of the hospitals to work in the community, which made them feel 'left in the lurch'.
He said: 'Care closer to home will just become a phrase rather than a reality unless something is done to support doctors in the community.'
Dr Irani said PCTs had been in a state of flux due to last year's reorganisation but he hoped they would now have time to recognise the value of specialist doctors.
The report proposes integrated provider organisations as a model for specialist healthcare in the community 'along the lines of polyclinics' proposed in junior health minister Lord Darzi's report Healthcare for London: a framework for action .
But David Stout, director of the NHS Confederation's PCT network, said managers would not be in favour of further reorganisations.
He said: 'It doesn't strike me as one of the biggest problems we are facing but it is an important part of how care is delivered.'
Specialist doctors include consultants, clinical medical officers and senior clinical medical officers and provide services including paediatrics, geriatrics, diabetes, dermatology and gynaecology.