title: Clinical and economic benefit of general practitioner integration to a symptomatic breast service.
abstract: BACKGROUND
  Integration of general practitioners (GPs) into a tertiary care team is a model used internationally to assist with provision of patient care. Symptomatic breast clinics have seen significant increases in attendances and consequential staffing issues. We wished to analyze the integration of GPs into a tertiary breast care team and establish whether their inclusion is a cost-effective approach.
  
  
  METHODS
  A prospectively maintained database was used to identify 1614 new and 1453 review patients seen in the clinic between September and December 2013. The triple assessment clinical, radiological, and biopsy scores of patients assessed by GPs were compared to those assessed by registrars and to the overall number of patients seen. A cost analysis was performed based on the hourly rates of GPs and registrars.
  
  
  RESULTS
  1614 new patients seen over the 4-month period. GPs reviewed a mean of 153.6 new patients and registrars reviewed a mean of 97.8. Registrars reviewed patients who were allocated higher 'S' scores, with 46 % of patients allocated an S4 and 21 % of patients allocated an S5 score. GPs reviewed a mean of 115.6 return patients and registrars reviewed a mean of 110.1 return patients. The weekly cost of employing 3 GPs for 15 h was €835. This compares favorably to the cost of employing a full-time registrar.
  
  
  CONCLUSIONS
  This study demonstrates that GPs can play a substantial role in the provision of a symptomatic breast service. In addition, the incorporation of GPs in this setting can prove cost-effective.
authors.affiliation: Department of Breast Surgery, Galway University Hospital, Galway, Ireland. suzub@hotmail.com.
authors.forename: S M
authors.initials: SM
authors.lastname: Beecher
authors.affiliation: Department of Breast Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Donlan
authors.affiliation: Department of Breast Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: D P
authors.initials: DP
authors.lastname: O'Leary
authors.affiliation: Department of Breast Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kerin
authors.affiliation: Department of Breast Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D058005:General Practitioners / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies
keywords: Breast; GP; General practitioner; Special interest