GP "gatekeeping" offers mixed benefits

A STUDY looking at GPs as gatekeepers to specialty care has concluded that this is associated with lower healthcare use and expenditure and better quality of care, but also lower patient satisfaction.

Researchers at Imperial College London reviewed 4,899 studies on various databases and focused on 25 related to gatekeeping and patient and health-related outcomes. They found that gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation, but one study reported unfavourable outcomes for patients with cancer under gatekeeping and concerns were raised about the accuracy of diagnoses made by gatekeepers.

The researchers also found that gatekeeping resulted in fewer hospitalisations and use of specialist care but inevitably more primary care visits. Evidence also pointed to lower patient satisfaction with gatekeeping than direct-access systems.

The study concluded: "Gatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction.

"Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies."

Commenting on the study, Professor Helen Stokes-Lampard, Chair of the RCGP, said: "Unlike most other healthcare systems around the world, the NHS is free at the point of need and so financial implications do not play any role in the gatekeeping function of UK GPs – most of the studies included in this systematic review were based in the US.

"While it's clear to see why UK GPs are often called the 'gatekeepers of the NHS', we will always put the needs of the individual patient first and refer anyone who we think might need secondary care intervention. However, this research also highlights a chronic lack of access to diagnostic tests in primary care, which can have a huge bearing on referral rates for conditions such as cancer.

"GPs take cancer diagnosis extremely seriously, and it's credit to our colleagues' hard work that 75 per cent of patients found to have cancer in the UK are referred after only one or two consultations, and that in the last five years the proportion of cancers diagnosed as an emergency dropped from 25 per cent to 20 per cent."

Link: Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review