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GPSIs dearer than the hospitals? No way!

From various

From Dr Scott Davison, Sheffield

Would you not agree it is rather misleading to say 'GPSIs are dearer than outpatient services' based, as far as I can tell from your article, on a study that looked at one clinic in Bristol (News, 17 December)?

The service models for GPSIs are very variable, as are the local outpatient costs. One cannot make such sweeping judgments, and I would hope Professor Salisbury agrees.

The other notable aspect was that the comparison appears to be being made with the tariff cost. Not all outpatient departments will meet that cost, so it is an erroneous comparator.

The other problem is that, where investigations such as CT and MRI are required, these are charged to the PCT and included in the average episode cost. By contrast, hospital trusts are able to lose these costs in the system and do not charge them to the outpatient episode.

When our GPSI ENT service has been running for a year, I am confident it will be considerably cheaper as well as better value, in terms of access and length of appointment, than the secondary care service. Time will tell.

From Dr Paul Charlson, GPSI in dermatology, Brough, East Yorkshire

I don't understand how GPSIs can price themselves out of the market. According to the research quoted (News, 17 December) GPSIs cost £208 per patient compared with £118 per patient for hospital outpatient dermatology.

I am a GPSI in dermatology: if I saw, say, 15 patients in a clinic according to the figures quoted, I would earn £3,120 per clinic. Generous administration fees, room rental and other overheads would come to about £750 per clinic.

This would leave me with £2,370 per clinic payment or about £120K a year for four mornings a month!

I think the figures quoted in the research are incorrect. It is quite easy to undercut the tariff rate of £118 per patient and still earn a reasonable hourly rate considerably above GP locum fees. GPSIs are a win-win scenario if used correctly and properly costed. They provide an accessible, cost-effective service.

· From Dr Peter Thomas

GPSI in ENT, Southampton City PCT

Your article highlighting the costs of the GPSI service study for dermatology clinics (News, 17 December) rightly emphasises the costs compared with outpatients services.

However, the same cannot be said for all GPSI clinics.The outpatient tariff for ENT makes the costs of GPSI-led services considerably cheaper than the hospital equivalents for ENT diagnosis and triage.

For dermatology there are considerable local variations in costs, accessibility and value added. Rapid appointment times have easily justified the existence of these clinics in many parts of the country.

The origin of GPSI clinics was initially controversial. Department of Health support via the Modernisation Agency has dried up with the demise of the agency, but in many parts of the country GPSIs are now a valued and respected referral choice which is very popular with patients.

We perform regular audits to justify our continued existence as the financial waters of PCT-provided services become more murky.

From Dr Sidha Sambandan, Norwich

The article on GPSIs makes no mention of the work done to reach such conclusions (News, 17 December).

It is common knowledge that GPSIs are paid differently in different parts of the country. Some clinics were set up with shoestring budgets; others are very well funded.

An outpatient first appointment costs in the region of £150, according to the national tariff. Are you saying that this particular GPSI is being paid much more than £300 a session?

The overhead in a hospital setting is much more than in a community hospital or general practice.

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