Results of study on walk-in centres are only to be expected

EDITOR—I was surprised by the obvious bias in the study by Grant et al comparing the quality of care in walk-in centres with that in general practice and from NHS Direct.1 The authors are astute enough to limit their conclusions to the range of conditions under study. I don't think there was much of a range. All the conditions assessed are classic walk-in conditions. Note also they are “conditions,” not patients. I doubt the walk-in clinics would have done so well with real standardised patients.

For example, for Mrs Smith who presents with coronary heart failure, deteriorating renal function, failing sight, diabetes, deafness, and no social support, general practice would have come into its own. Walk-in clinics can perform quick tasks well, or they would be out of business. Grant et al might as well have compared the management of these “cases” by obstetricians if they want walk-in clinics to look good. What is interesting is that the general practitioners did do a complete job on the cases with the lowest referrals. They created less work for others and avoided unnecessary costs for the system.

The choice of cases set general practice up to do comparatively badly by limiting them to the easy procedures that walk-in clinics can handle. The conclusion might be that walk-in clinics do a limited range of easy things adequately but refer more than is needed.