Specialist general practitioners and diabetes clinics in primary care: a qualitative and descriptive evaluation.
OBJECTIVE
The aim of this study was to evaluate an innovative approach to the provision of primary care-based diabetes services in Bradford, UK. The service model differs from others in comprising 19 clinics which offer a specialist service, intermediate between primary and secondary care, to all patients within the Bradford area.


METHODS
The study included: analysis of referral, attendance and register data; questionnaires to general practitioners (GPs) and specialist clinic providers; qualitative interviews with clinic and other professional staff and patients; and an economic analysis.


RESULTS
The 19 clinics adopt a range of organizational models. In the first 3 1/2 years, 2415 patients were referred. There was a significant reduction in out-patient attendances at hospital, but also a significant increase in overall patient attendances. Specialist clinic patients differed from hospital patients in being older and having had diabetes for longer since diagnosis. Ten of the 14 clinics run by practising GPs attracted more referrals from within their practices than from outside. GPs and patients across the city believed the clinics were valuable, the main benefits being geographical accessibility, availability of specialists in a community setting, short waiting times for first appointments at most clinics, and continuity of staff. Their reservations included a lack of strategic planning in the location of clinics, long waiting times at some clinics, and poor communication at some clinics with referring GPs. The cost of the primary care clinics is similar to hospital clinics.


CONCLUSIONS
This model of specialist primary care services offers an opportunity to develop diabetes services that are convenient to patients, popular with practitioners, and increase capacity. However, the shortcomings as well as the advantages of the model need to be addressed if it is to be implemented elsewhere or for other patient groups.
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Department of Clinical Epidemiology and Public Health, Bradford Hospitals NHS Trust, Bradford, UK.
Rhodes
P J
PJ
Wright
J P
JP
Eastham
J
J
Williams
D R R
DR
Harrison
S R
SR
Young
R J
RJ
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D009936:Organizational Innovation; D010342:Patient Acceptance of Health Care; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012017:Referral and Consultation; D012042:Registries