What next for gatekeepers?

Part of the burgeoning workload of GPs in the United Kingdom is being an NHS gatekeeper. Successful gatekeeping is a challenge, and poor decisions have consequences. Over-referral risks inappropriate use of resources, while under-referral risks potential harm and dissatisfaction among patients. Direct access to specialists may sound appealing: it could reduce GPs’ workload as well as widening patients’ access. But what would be the effect on secondary care? This week Geva Greenfield and colleagues ask whether it’s time to rethink primary care’s gatekeeper role (doi:10.1136/bmj.i4803). They argue that “a …