title: What proportion of adult allergy referrals to secondary care could be dealt with in primary care by a GP with special interest?
abstract: BACKGROUND
  The concept of a General Practitioner with Special Interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialised treatment closer to the patient's home and reducing hospital waiting times. Given the patchy and inadequate provision of allergy services in the UK the introduction of GPwSIs might reduce the pressure on existing specialist services.
  
  
  OBJECTIVE
  This study assessed what proportion of referrals to a specialist allergy clinic could be managed in a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of advice on allergen avoidance; ability to assess suitability for desensitisation).
  
  
  METHODS
  100 consecutive GP referrals to a hospital allergy clinic were reviewed to determine whether patients could be seen in a community-based clinic led by a general practitioner with special interest (GPwSI) allergy. The documentation relating to each referral was independently assessed by three allergy specialists. The referrals were judged initially on the referral letter alone and then re-assessed with the benefit of information summarised in the clinic letter, to determine whether appropriate triage decisions could be made prospectively. The proportion of referrals suitable for a GPwSI was calculated and their referral characteristics identified.
  
  
  RESULTS
  29 % referrals were judged unanimously appropriate for management by a GPwSI and an additional 30 % by 2 of the 3 reviewers. 18 % referrals were unsuitable for a GPwSI service because of the complexity of the presenting problem, patient co-morbidity or the need for specialist knowledge or facilities.
  
  
  CONCLUSIONS
  At least a quarter, and possibly half, of allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on more complex cases and reducing the waiting time for first appointments.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Room 319, Mayfield House, Falmer, Brighton, BN1 9PH UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Smith
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Room 319, Mayfield House, Falmer, Brighton, BN1 9PH UK.
authors.forename: J
authors.initials: J
authors.lastname: Wade
authors.affiliation: Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Frew
keywords: Adult patients; Allergy; Commissioning; GP with special interest; Referral letter