Research suggests that health systems based on the GP as gatekeeper to specialty care reduce healthcare use and expenditure, and is linked with better quality of care. However, it is also associated with lower patient satisfaction and unfavourable outcomes for patients with cancer.
The systematic review, published in the British Journal of General Practice, identified relevant studies published on MEDLINE, PreMEDLINE, Embase, and the Cochrane Library. Two authors independently screened search results and assessed the quality of studies.
Twenty-five studies were included in the final analysis.
Overall, GPs acting as gatekeepers was linked better quality of care, especially in terms of preventive care and appropriate referral for specialty care and investigation. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but with more primary care visits.
However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers.
Patients were less satisfied with gatekeeping than direct-access systems.
The authors said: “Although gatekeeping may be associated with a reduction in specialist healthcare use and resulting financial benefits, a possible association with delayed diagnosis, particularly in the context of cancer care, is of significant concern.”