BMJ 1994;308:1053 (23 April)

Editorials

Specialist outreach clinics

On p 1083 Jacqueline Bailey and colleagues confirm the rapid growth in specialist outreach clinics in general practice.1 Should this trend be encouraged or opposed? Until such clinics have been properly evaluated the authors recommend that we suspend our judgment.

Like every other intervention, such clinics should fulfil Brook's definition of appropriate care - "that for which the benefits exceed the risks by a wide enough margin to make it worth providing."2 Neither expanding the range of services available in primary care nor addressing some of the in- efficiencies of the secondary sector is sufficient justification for their existence. (It is not for general practitioners to become Don Quixotes, righting the wrongs of the NHS.) The piecemeal provision of consultant outreach clinics is also likely to widen further the divisions that currently exist within general practice.

Bailey et al's survey shows that doctors prize efficiency and accessibility over equity or . . . [Full text of this article]


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