@article {Westwoode191, author = {Greta Westwood and Ruth Pickering and Sue Latter and Paul Little and Karen Gerard and Anneke Lucassen and I Karen Temple}, title = {A primary care specialist genetics service: a cluster-randomised factorial trial}, volume = {62}, number = {596}, pages = {e191--e197}, year = {2012}, doi = {10.3399/bjgp12X630089}, publisher = {Royal College of General Practitioners}, abstract = {Background GPs do not have the confidence to identify patients at increased genetic risk. A specialist primary care clinical genetics service could support GPs with referral and provide local clinics for their patients.Aim To test whether primary care genetic-led genetics education improves both non-cancer and cancer referral rates, and primary care-led genetics clinics improve the patient pathway.Design and setting Cluster-randomised factorial trial in 73 general practices in the south of England.Method Practices randomised to receive case scenario based seminar (intervention) or not (control), and referred patients a primary (intervention) or secondary (control) care genetic counsellor (GC)-led appointment. Outcome measures: GP referral and clinic attendance rates (primary), appropriate cancer and case scenario referral rates, patient satisfaction, clinic costs, and case management (secondary).Results Eighty-nine and 68 referrals made by 36 intervention and 37 control practices respectively. There was a trend towards an overall higher referral rate among educated GPs (referral rate ratio [RRR] 1.34, 95\% confidence interval [CI] = 0.89 to 2.02; P = 0.161), and they made more appropriate cancer referrals (RRR 2.36, 95\% CI = 1.07 to 5.24; P = 0.035). No indication of difference in clinic attendance rates (odds ratio 0.91, 95\% CI = 0.43 to 1.95; P = 0.802) or patient satisfaction (P = 0.189). Patients spent 49\% less travelling ({\textsterling}3.60 versus {\textsterling}6.62; P\<0.001) and took 33\% less time (39.7 versus 57.7 minutes; P\<0.001) to attend a primary than secondary care appointment; 83\% of GC-managed appointments met the 18-week referral to treatment, NHS target.Conclusion An integrated primary care genetics service both supports GPs in appropriate cancer referral and provides care in the right place by the right person.}, issn = {0960-1643}, URL = {https://bjgp.org/content/62/596/e191}, eprint = {https://bjgp.org/content/62/596/e191.full.pdf}, journal = {British Journal of General Practice} }