Routine telephoning of outpatients should become standard practice if reducing non-attendance is thought to be desirable, but general practitioner (GP) referral letters and hospital records of current hospital outpatients need to include an up-to-date telephone number. Consideration should be given to 'out-of-hours' reminder calls to maximize the contact rate.

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SummaryAims: To establish a Community Respiratory Assessment Unit and to evaluate its role in enhancing the accuracy of respiratory diagnosis in primary care. Methods: We established a central and peripatetic nurse-led service utilising semi-structured history taking, spirometry, oxygen saturation monitoring and semi-structured reporting, coupled with the provision of educational materials to both primary care physicians and patients. Results: Phased access to the service was offered to 32 general practices. Use varied widely between practices and a total of 364 patients were referred in the first year. The single biggest diagnostic group consisted of patients with definite or suspected COPD, but the diagnosis was often not confirmed. Patient and GP satisfaction with the service was extremely high; without it misdiagnoses and inappropriate therapeutic trials are possible. Conclusion: A community respiratory assessment unit such as this is one way of offering a centrally-directed, quality-controlled, diagnostic support service for primary care physicians.

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