Should consultant surgeons see new or follow-up patients? A prospective audit of a change in clinic organisation.

In the traditional surgical clinic consultants assess new referrals (NP) and trainees follow-up patients (FP). To improve the management of FP and to increase trainee teaching a clinic was changed so trainees assessed NP (under supervision) and the consultant FP. A prospective audit was conducted two months before and two and six months after the change. A further audit four years later included a questionnaire to trainees, patients, General Practitioners (GP) and nurses. Before the change the proportion of NP to FP was 1:1.9. Six months later FP were reduced by 28 per cent. Four years later the proportion of NP to FP was 1:1.6. The consultant was more likely to discharge follow-up patients and shortened the interval between follow-up appointments. Questionnaires revealed that many GPs (59 per cent) would accept less consultant involvement with NP if this increased FP discharges. All trainees and most nurses (83 per cent) preferred the rearranged clinic. NP found initial assessment by trainees acceptable and FP noted the greater consultant input. This study suggests that consultant surgeons should review more FP and this can be achieved without reducing NP consultations. This arrangement is acceptable to patients and improves training. Guidelines recommending that consultants see all NP should be reconsidered.