Imperial College London


Faculty of MedicineSchool of Public Health

Research Fellow in Public Health



+44 (0)20 7594 8595g.greenfield Website




314Reynolds BuildingCharing Cross Campus






BibTex format

author = {Greenfield, G and Foley, K and Majeed, A},
doi = {10.1136/bmj.i4803},
journal = {BMJ},
title = {Rethinking primary care's gatekeeper role.},
url = {},
volume = {354},
year = {2016}

RIS format (EndNote, RefMan)

AB - Gatekeeping is the term used to describe the role of primary care physicians or general practitioners (GPs) in authorising access to specialty care, hospital care, and diagnostic tests.1 Gatekeeping has crucial influences on service utilisation, health outcomes, healthcare costs, and patient satisfaction.In the UK access to NHS and private specialists is generally possible only after a referral from a GP. Gatekeeping was developed as a response to a shortage of specialists and a desire to control healthcare spending2 and has been an accepted practice in the UK for over 100 years.3 The NHS is under considerable pressure to use its resources efficiently, and primary care has helped the NHS to achieve this goal through its gatekeeping function.4 Yet direct access could help reduce GP workload and facilitate greater patient choice. We look at the pros and cons of gatekeeping, describe gatekeeping policies in various countries, and highlight the need for more evidence to devise policy.
AU - Greenfield,G
AU - Foley,K
AU - Majeed,A
DO - 10.1136/bmj.i4803
PY - 2016///
SN - 0959-8138
TI - Rethinking primary care's gatekeeper role.
T2 - BMJ
UR -
UR -
VL - 354
ER -