The proportion of general practitioner referrals to a hospital Respiratory Medicine clinic suitable to be seen in a GPwSI Respiratory Clinic

Abstract

SummaryAims: The purpose of this study was to examine the proportion of general practitioner (GP) referrals to a hospital Respiratory Medicine clinic which might be suitable for a General Practitioner with a Special Interest (GPwSI) Respiratory Clinic. Method: All GP referral letters to the Respiratory Medicine Department of a teaching hospital, apart from urgent cancer referrals, were identified from two two-week periods. All patient and practice identifications were removed. Two GPs and one Consultant Respiratory Physician assessed each of the anonymised referral letters to determine the patient's suitability to be seen in a GPwSI Respiratory Clinic, assuming such a clinic had a predetermined range of investigative facilities. Results: Out of 96 referrals covering a wide range of respiratory conditions apart from lung cancer, 22 (23%) were considered by all assessors to be suitable for a GPwSI clinic, and there was full agreement that 40 referrals (42%) were unsuitable. The other 34 referrals (35%) had varying degrees of agreement on suitability. The largest groups of patient referrals considered suitable for a GPwSI clinic were those with chronic obstructive pulmonary disease (COPD) or cough as the main presenting clinical problem. The commonest groups considered unsuitable were referrals of patients with an abnormal chest radiograph, haemoptysis, or possible interstitial lung disease. * Corresponding author. Tel.: +44 (0) 1603 443300; fax: +44 (0) C o p y r ig h t G e n e r a l P r a c t ic e A ir w a y s G r o u p R e p r o d u c t io n p r o h ib it e dThe proportion of general practitioner referrals to a hospital Respiratory Medicine clinic 315Conclusion: This small study has shown that at least a fifth of GP referrals to a hospital Respiratory Medicine clinic could be seen in a suitably resourced GPwSI clinic, with consequent reductions in hospital outpatient waiting lists and improved accessibility for patients. This finding will be of interest to potential commissioners of GPwSI services especially with the advent of Practice-based Commissioning.

How many paediatric referrals to an allergist could be managed by a general practitioner with special interest?

“…As this study was an exploratory study, there are no comparative estimates of the proportion of paediatric allergy referrals that could be managed by a GPwSI in allergy. However, two studies have undertaken a similar exercise for referrals to adult outpatient clinics, one specializing in respiratory problems and the other for allergy . In adult respiratory medicine, the proportion of referrals judged appropriate for a GPwSI was 23%, with unanimous agreement and variable degrees of agreement for a further 35%; for adult allergy, the values were 29% and 30%, respectively.…”

Systems for the management of respiratory disease in primary care — an international series: United Kingdom

“…Referrals for specialist advice can be to a secondary care respiratory physician, or in some localities (mainly in England) respiratory GPwSIs are providing community-based referral services for specific conditions such as COPD or asthma. [81][82][83][84] Although the formal accreditation process (normally based on a portfolio of professional training and experience) addresses the governance requirements for the delivery of a clinical service, 85 many GPwSIs also have an important strategic and training role within their locality. 27 In 2006, 38% of PCOs had, or were considering developing, a respiratory GPwSI service.…”

Primary care research and clinical practice: respiratory disease

“…The General Practice Airways Group has, however, been influential in recognising the potential of primary care practitioners to have an important strategic, educational and clinical role in the delivery of specialist care for people with long-term respiratory diseases 63. Primary care research has contributed to the understanding of the multifaceted roles of respiratory GPwSIs,64 – 66 and recently published work has provided further insights into how primary care organisations reconfigure their workforce to provide services for people with long-term respiratory disease 67 68. Provision of community-based pulmonary rehabilitation and leading the development of local services for people with severe COPD are practical examples of the GPwSI role.…”