General practitioners with special clinical interests

Editor—Rosen et al mention the sparsity of evidence concerning the effectiveness of general practitioners in a clinical role.¹ In 1999, with the support of the local health authority and more recently Torbay primary care trust, I established a cardiac diagnostic service based at my surgery. It provides echocardiography, exercise electrocardiography testing, and ambulatory electrocardiography monitoring.

The results of the first audit were as follows. During the first 12 months 271 echocardiograms, 95 exercise electrocardiograms and 125 ambulatory electrocardiograms were produced. The average wait for each test was two weeks. Results were posted to the referring general practitioner on the same day as the test. Referring general practitioners were asked to state what proportion of patients referred would have been referred to the local hospital if they had not been referred to the service, and the result was 93%. They were then asked how many were referred after the test was done. and the result was 12%.

Thus some 397 hospital cardiology referrals were saved in the first year. The service is continuing and we now have an average of 750 referrals per year.