Although a full cost-analysis was not detailed in this paper, there are cost savings to both patient and trust without the concern of additional expenditure that Middleton has raised.
Review of the referral letters is undertaken in the usual manner and patients with suspected carpal tunnel syndrome are sent an information sheet and telephoned by the secretary, who explains what is involved and their likely recovery if surgery is performed. Patients are then given an appointment at a one-stop clinic or a routine appointment if they decline this service. We do not perceive any appreciable cost in this process.
The arrangements for the clinic are that the first patient is seen at 1.30 pm in the pre-assessment clinic area, with no other clinics being cut to accommodate it. The first patient is taken to theatre at 2.00 pm and a registrar performs the operation. The subsequent patients are operated on by me or a registrar or SHO under my supervision, and we have found the clinic very useful for teaching junior surgeons to perform carpal tunnel decompression. There is, therefore, no under utilisation of theatres. Additionally, in the weeks when I am not doing the one-stop clinic, I would either be doing an out-patient clinic or have no NHS commitments, and the theatre is used for a staff-grade day-case list.
As is detailed in the paper, follow-up is arranged with the general practitioner for removal of sutures and wound care. This, in addition to the fact that they only have to attend the hospital once, will reduce the costs to the patient in terms of transportation and lost work days.
We would encourage others to set up a similar clinic.