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Special interest GPs 'not cost-effective?'

The Government's drive to increase the number of GPs with special interests may not be cost-effective and is not guaranteed to cut waiting hospital waiting lists either, according to experts in primary care.

A review on GPwSIs published in this month's British Journal of General Practice said the 'driving force' behind the NHS Plan target of 1,000 GPwSIs by 2004 was meeting policy objectives such as cutting waiting times.

Experts at the centre for research in primary care at the University of Leeds found although having GPwSIs cut waiting times in ENT, endo-scopy and cytoscopy, referrals to dermatology clinics and for minor surgery remained high.

They found that 40-80 per cent of ENT referrals could potentially be dealt with by GPs.

They also warned 'it is not clear that GPwSIs are cost-effective' as cost comparisons between GPwSIs and hospitals are 'fraught with difficulties'.

The review said GPwSIs would be a 'substantial feature in primary care' but several important 'shortcomings' have yet to be addressed including distribution of services and systems of referral.

An independent evaluation of six pilot GPwSIs ­ conducted by the York Health

Economics Consortium and flagged up in the NHS

Modernisation Agency's annual report ­ found treatment costs could be halved by using a GPwSI instead of an acute consultant.

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