SPECIALIST OUTREACH CLINICS IN GENERAL-PRACTICE - WHAT DO THEY OFFER

Background. Specialist outreach clinics in general practice, in which hospital-based specialists hold outpatient clinics in general practiti oners' (GPs) surgeries, are one example of a shift in services from se condary to primary care.Aim. To describe specialist outreach clinics h eld in fundholding general practices in two specialties from the persp ective of patients, GPs, and consultants, and to estimate the comparat ive costs of these outreach clinics and equivalent hospital outpatient clinics. Method. Data were collected from single outreach sessions in fundholding practices and single outpatient clinics held by three der matologists and three orthopaedic surgeons. Patients attending the out reach and outpatient clinics, GPs from practices in which the outreach clinics were held, and the consultants all completed questionnaires. Managers in general practice and hospital finance departments supplied data for the estimation of costs. Results. Initial patient questionna ires were completed by 83 (86%) outreach patients and 81 (75%) outpati ents. The specialist outreach clinics sampled provided few opportuniti es for increased interaction between specialists and GPs. Specialists were concerned about the travelling time resulting from their involvem ent in outreach clinics. Waiting times for first appointments were sho rter in some outreach clinics than in outpatient clinics. However, pat ients were less concerned about the location of their consultation wit h the specialist than they were about the interpersonal aspects of the consultation. There was some evidence of a difference in casemix betw een the dermatology patients seen at outreach and those seen at outpat ient clinics, which confounded the comparison of fetal costs associate d with the two types of clinic. However, when treatment and overhead c osts were excluded, the marginal cost per patient was greater in outre ach clinics than in hospital clinics for both specialties studied. Con clusion. The study suggests that a cautious approach should be taken t o further development of outreach clinics in the two specialties studi ed because the benefits of outreach clinics to patients, GPs and consu ltants may be modest, and their higher cost means that they are unlike ly to be cost-effective.