Long-term follow-up in outpatient clinics. 1: The view from general practice

Nearly three-quarters of patients seen in specialist outpatient clinics in England are in follow-up. It has been suggested that the care of many of these patients could be transferred to general practice.

We aimed to estimate the proportion of patients in general practice who are in long-term outpatient follow-up, and to identify GPs' perspectives on the appropriateness and implications of the discharge of their patients to primary care.

Prevalence data were collected by identifying correspondence from outpatient clinics to GPs in four Manchester practices (population 29,000). GPs were asked to assess the suitability for discharge of their patients who were seen in medical outpatient clinics. Semi-structured interviews were carried out with 15 of these GPs, and with 11 GPs who had patients recently discharged from medical clinics.

At least 4.5% of the practice populations were in long-term outpatient follow-up (median duration 25 months). These patients had consulted their GP a median of seven times during the previous year. GPs were willing to take over the care of 48% of patients in medical clinics, and in many cases did not expect that this would lead to an increase in their workload. Some resource needs were identified in general practice, and improvements to the process of discharge were suggested.

The need for continued follow-up in outpatient clinics should be reviewed. Many patients could be discharged without increasing GPs' workload. For more complex cases, additional resources may be needed to provide co-ordinated care within general practice. When patients are discharged, GPs need information quickly and need access to specialist advice for their patients when necessary without long delays.