A potentially valuable asset, which requires evaluation

The NHS Plan called for the introduction of 1000 “specialist general practitioners” to establish clinics in community settings for carefully selected patients.1 A key aim is to improve access in specialties that have particularly long waiting times, such as otorhinolaryngology, dermatology, and ophthalmology. Theoretically at least, hospital consultants will then be able to offer faster access to patients with more complex problems as more straightforward cases are diverted to clinics run by general practitioners with special clinical interests.

The success of this policy will depend on recruiting and developing a cadre of general practitioners with the necessary knowledge and skills to provide specialist care. It will also depend on developing and implementing appropriate selection criteria to ensure that patients see a specialist–be it a general practitioner or a hospital consultant–who is equipped to deal with their clinical problem. This in turn raises three important questions. How do we ensure the quality of a general practitioner specialist service? Will the services be clinically effective and cost effective? What will be their impact on the dynamics of outpatient specialist care?

General practitioners with special clinical interests are not a new breed.2 Many work as clinical assistants in hospital departments, and others pursue a special interest in their own surgery, taking referrals from other partners in their …