The case for widening the referral system.

General practitioners (GPs) in the United Kingdom are vigorous in their defence of their sole right to refer a patient to a specialist. However, a strong case can be put for allowing access to specialist services through other channels of referral such as open access clinics, direct referral by district nurses, residential and nursing home managers or social workers. GPs and hospital consultants have long-established work patterns and are likely to be reluctant to change. But if all patients are to receive the level of expertise to which they are entitled, the barriers at the hospital/community frontier will have to come down.