BMJ 1994;308:1083-1086 (23 April)
General practice
Specialist outreach clinics in general practice
J J Bailey,
M E Black,
D Wilkin
Centre for Primary Care Research, Department of General Practice, University of Manchester, Rusholme Health Centre, Manchester M14 5NP20 Correspondence to: Dr Bailey.
Abstract
Objectives : To establish the extent and nature of specialist outreach clinics in primary care and to describe specialists' and general practitioners' views on outreach clinics.
Design : Telephone interviews with hospital managers. Postal questionnaire surveys of specialists and general practitioners.
Setting : 50 hospitals in Englands and Wales.
Subjects : 50 hospital managers, all of whom responded. 96 specialists and 88 general practitioners involved in outreach clinics in general practice, of whom 69 (72%) and 46 (52%) respectively completed questionnaires. 122 additional general practitioner fundholders, of whom 72 (59%) completed questionnaires.
Main outcome measures : Number of specialist outreach clinics; organisation and referral mechanism; waiting times; perceived benefits and problems.
Results : 28 of the hospitals had a total of 96 outreach clinics, and 32 fundholders identified a further 61 clinics. These clinics covered psychiatry (43), medical specialties (38), and surgical specialties (76). Patients were seen by the consultant in 96% (107) of clinics and general practitioners attended at only six clinics. 61 outreach clinics had shorter waiting times for first outpatient appointment than hospital clinics. The most commonly reported benefits for patients were ease of access and shorter waiting times.
Conclusions : Specialist outreach clinics cover a wide range of specialties and are popular, especially in fundholding practices. These clinics do not seem to have increased the interation between general practitioners and specialists.
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- Provision of specialist outpatient services in primary care has been increasing
- In this study over half of all provider units had established outreach clinics in a wide range of specialties
- Developments in outreach clinics since 1990 have been concentrated in fundholding practices
- Care is mainly provided by specialists with little interaction between specialists and general practitioners
- Cost effectiveness, patient satisfaction, and outcome need to be evaluated in outreach clinics
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