Efficacy of general practitioners with specialty interests for surgical procedures

Abstract

Background: General practitioners with specialty interests (GPwSIs) have been an emerging entity in the last decade or so and aim to improve patient's access to specialist level care in the primary care setting. This is achieved by them providing equivalent quality and outcomes to secondary consultant-led services, while not necessarily providing the same breadth of clinical care as them. In this systematic review, we attempt to address their efficacy for surgical procedures and specialties. Methods: PRISMA guidelines were followed and an electronic literature search was performed independently by two authors using predefined search terms across EMBASE, Ovid MedLine, PubMed, PSYCINFO and the Cochrane Library databases. A total of 817 articles were reviewed after which only six were included for the systematic review. Results: Of the six articles selected, three studies analysed efficacy of GPwSIs with regard to surgical excision of skin lesions. One study looked at the economic evaluation of a GPwSI-led dermatology service in primary care and included GPwSIs carrying out skin excisions. The remaining two included studies were from the same institution and evaluated hernia repairs at a single centre general practitioner practice. Conclusion: There is generally, a paucity of evidence looking at the efficacy of GPwSIs for surgical procedures. While they seem to provide an acceptable standard of specialist care in the primary care setting, they do not appear to save money. However, they provide an alternative workforce and the improved access to care that results from it may offset their higher costs.

Healthcare utilization and management of actinic keratosis in primary and secondary care: a complementary database analysis

“…antibiotics) and limiting patients entering secondary care . Examples of the effect of additional training can be seen with dedicated and specialized GPs in Australia and the U.K., where they have a greater role in skin cancer management . In addition, further structuring of AK management, including explicit criteria for referral (e.g.…”

“…19,37,40,48,49 Examples of the effect of additional training can be seen with dedicated and specialized GPs in Australia and the U.K., where they have a greater role in skin cancer management. [50][51][52] In addition, further structuring of AK management, including explicit criteria for referral (e.g. AK not responding to treatment, AK in immunosuppressed patients, AK with the potential of SCC), may provide a substantive potential to lower the burden in secondary care.…”

A regional programme to improve skin cancer management

“…This general upskilling of GPs has achieved a comparable standard of excisions to those reported for several GPwSI services. [22][23][24] The advantage of our programme is that it provides a wider base of competent practitioners, more convenient access to care for patients, and avoids the costs of accrediting doctors.…”

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

“…172 Earlier models of providing specialist care in the community include interventions that involve the transfer of services where primary care substitutes for secondary care [e.g. GPs with specialist interests (GPwSIs) 71,173,174 or the relocation of services from secondary care to primary care settings). [174][175][176][177][178] More recently, the ways in which specialist care is being implemented in primary care go beyond the 'drag and drop' approach of simply relocating a hospital outpatient clinic into a community setting; instead, methods that put education at the core alongside the redesign of the patient pathway and/or the role of the professional are becoming more established.…”

“…164,181 In general, studies reporting on the transfer of care from secondary to primary care have reported that the quality of care achieves an acceptable standard. 71,173,174 The safety of diagnostic services transfer is equivocal; a literature-mapping exercise 175 found evidence that the quality (including diagnostic accuracy and the appropriateness of test ordering) and safety of diagnostic service provision in the community is mixed.…”