SynthesisThe British journal of general practice : the journal of the Royal College of General Practitioners2019
Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review.
Synthesis in The British journal of general practice : the journal of the Royal College of General Practitioners, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07474584 (The OpRESTORE AI-Patient Navigator Study), which is not on this map. Cited by 97 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The OpRESTORE AI-Patient Navigator Study: Developing and Testing an AI-enhanced Patient Navigator for UK Veterans With Service-related Physical Health Problems
Who cites it
97 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Navigating healthcare, managing life, or falling through the cracks? A theory-informed systematic review of the chronic burden faced by women with recurrent urinary tract infections.BMC public health · 2026Pooled it
- The implementation challenge of computerised clinical decision support systems for the detection of disease in primary care: systematic review and recommendations.Implementation science : IS · 2025Pooled it
- Uptake of patient enrolment in primary care and associated factors: a systematic review and meta-analysis.BMC primary care · 2025Pooled it
- Evidence on bringing specialised care to the primary level-effects on the Quadruple Aim and cost-effectiveness: a systematic review.BMC health services research · 2024Pooled it
- What is known about adolescent dysmenorrhoea in (and for) community health settings?Frontiers in reproductive health · 2024Pooled it
- Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence.BMC health services research · 2023Pooled it
- Diagnostic delay of myositis: an integrated systematic review.Orphanet journal of rare diseases · 2022Pooled it
- What affects unplanned hospital admissions in older adults according to primary healthcare professionals? A focus group study.The European journal of general practice · 2026Article
- Telephone triage in urgent unscheduled primary care in 16 European countries: a cross-national questionnaire-based expert study.Scandinavian journal of primary health care · 2026Article
- Exploring perceived access to and previous experiences with general practice and associations with health literacy in the Danish population.Scandinavian journal of primary health care · 2026Article
- [Patient management and patient autonomy: An ethical tension?]Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Article
- [A primary care system in Germany: evidence, opportunities, and implementation].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Review
- [Patient management and personal responsibility as part of a statutory health insurance reform: possible approaches for Germany].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Article
- Patient Expectations, Satisfaction and Perceptions of Specialization in Family Medicine: A Cross-Sectional Study from a Health Literacy Perspective in Türkiye.Healthcare (Basel, Switzerland) · 2026Article
- Impact of a high-profile sudden cardiac death on emergency department utilization: a multi-campus interrupted time series and exploratory phenotyping study.BMC emergency medicine · 2026Article
- Assigned But Not Anchored: A Study of Primary Care Provider Utilization Among Covered California Enrollees.Journal of general internal medicine · 2026Article
- Association of General Practice Continuity With Hospital Admissions and Costs: A Retrospective Study.Annals of family medicine · 2026Article
- Prescription Medication Access Among Immigrant and Refugee Populations in Canada: A Scoping Review.Journal of immigrant and minority health · 2026Review
- Use of general practitioner services among high-cost older patients in somatic hospitals - a Norwegian registry-based study.BMC health services research · 2026Observational
- Expectations Shaped Elsewhere: Refugee Experiences of Healthcare in Aotearoa New Zealand.Health expectations : an international journal of public participation in health care and health policy · 2026Article
37 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGPs often act as gatekeepers, authorising patients' access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes.
aimTo establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction. DESIGN AND
settingA systematic review.
methodThe databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies.
resultsElectronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. 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. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems.
conclusionGatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.