Efficacy of general practitioners with specialty interests for surgical procedures

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.