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Impact of GP gatekeeping on quality of care, health outcomes, health care use, and spending

In many health systems, primary care physicians (sometimes referred to as general practitioners or family physicians) regulate access to specialist medical services and investigations. This process is sometimes described as “gatekeeping” and is a response to a shortage of specialists and a need to control healthcare spending. In gatekeeping systems, patients are required to visit a GP or primary care physician to authorise access to specialty care. However, the effectiveness of gatekeeping remains unclear.

In a systematic review published in the British Journal of General Practice, we examined the impact of gatekeeping on areas such as the quality of health care, healthcare spending and use, and health-related and patient-related outcomes.

We found an an association between gatekeeping and better quality of care, especially in terms of preventive care, and appropriate referral for specialty care and investigation. However, we found one study that reported unfavourable outcomes of patients with cancer under gatekeeping.

Gatekeeping resulted in fewer hospitalisations and lower specialist use, but also led to more primary care visits. Gatekeeping may also lead to lower healthcare use and expenditure. Primary care clinicians have conflicting views on gatekeeping, whereas patients are often less satisfied with gatekeeping schemes, preferring health systems where they have direct access to specialists.

As with many areas of health policy, the impact of gatekeeping on key health system metrics needs further investigation to help devise more efficient and equitable health systems that improve health outcomes and lead to high patient satisfaction whilst at the same time, keeping spending on health services at sustainable levels.

Lambeth CCG 2017 Award for Outstanding Contribution to Primary Care

I was very honoured to have won the 2017 Lambeth CCG Award for Outstanding Contribution to Primary Care. Lambeth CCG noted that “Dr Majeed has made a huge contribution to primary care research and teaching, as well as providing high quality kind care to his patients in Clapham, where he has worked as a GP for over 20 years. Dr Majeed was also recognised recently in Pulse magazine as one of the 50 most influential GPs in the UK.”

Why I became a mental health champion at Imperial College London

As a doctor with many years experience of working in the NHS, I am aware of the impact that mental health problems can have on people’s health, well-being and quality of life, as well as on their family and friends. Mental health problems are also important for employers, and result in considerable financial costs in lost production and in staff absences from the work-place due to ill-health. However, even though mental health problems are very common, many people find it difficult to talk about them.

Encouraging a supportive environment in the workplace that reduces the risk of mental health problems developing – and in supporting staff to seek help when mental health problems do arise – is very important for employers. It improves employees’ health and well-being, and creates a more productive and pleasant working environment.

As a Mental Health Champion for the School of Public Health at Imperial College London, I see my role as supporting my departmental colleagues to achieve these objectives and ensure that mental health issues in the workplace are given the prominence they deserve. I want college staff to feel they can discuss any mental health problems they are experiencing in an open and constructive manner, and not feel pressurised to keep their mental health problems hidden from their colleagues.