Under conventional systems of care, outpatient clinics see patients referred by a GP for clinical assessment by a hospital specialist. Subsequent hospital visits are arranged to undertake any specialist diagnostic tests that may be required and to initiate treatment where necessary. In other words, the specialist in the outpatient clinic acts as a gatekeeper to other hospital resources. Allowing the GP to bypass this gatekeeper and gain ‘direct access’ to tests can enable GPs to make more efficient use of hospital resources and reduce waiting times for patients.
Direct access to diagnostic services should reduce outpatient attendance in that GPs may refer patients for diagnostic testing without prior consultant assessment. Waiting time from presentation to testing is accordingly reduced. If the patient can be managed by the GP without subsequent referral to a consultant, waiting time from presentation to treatment is also reduced and further outpatient attendance avoided. However, direct access may increase demand for testing and lead to less appropriate referrals with a consequent reduction in diagnostic yield. It is also possible that the quality of care will decline if GPs fail to take appropriate clinical action in response to test results. All other factors being equal, the direct cost to …