EDITOR, - The medical press has widely reported that outreach clinics do not seem to have improved communication between general practitioners and specialists. In the case of fundholding practices this conclusion cannot be drawn from the paper by Jacqueline Bailey and colleagues, who measured only how often general practitioners attended outreach clinics.1 There are many more efficient ways of communicating and learning than attending clinics. In my practice, which has five in house clinics, specialists discuss their cases over a working lunch attended by all partners and the practice's clinic nurse. We think that communications have improved greatly.

Bailey and colleagues state that fundholders had initiated their clinics. Presumably they arranged to communicate with specialists at other times. In the table showing the advantages to fundholders of outreach clinics, communication with specialists was mentioned most commonly and educational value was second. The outreach clinics have probably led to improved communications, but the authors' assessment based solely on general practitioners' attendance failed to show this.

A further weakness of the paper is that it compares the incomparable. The result is meaningless. Outreach clinics set up in health centres during the 1970s largely by psychiatrists are simply collocations of services. They cannot be compared with in house clinics set up recently for other specialties in fundholding practices. In house clinics have resulted in better use of resources by improving the accuracy of referral and reducing unnecessary review. The clinics are popular with patients, who find them convenient and like the familiar setting. In our experience they lead to improved …