Oil company. This letter calls upon the President and House to take appropriate action, but makes no suggestion as to what that might be. Companies. Are general practitioners with special interests likely to be an effective and cost effective way of providing care? A randomised controlled trial by Salisbury et al and an economic evaluation by Coast et al provide some answers.1 2 The results show that in dermatology a general practitioner with special interest service was effective: patients were seen more quickly, were more satisfied, and had similar clinical outcomes when compared with those seen in a specialist clinic. However, the NHS costs of referring patients to a general practitioner with special interest were 75% more than for specialist clinics. The main reason for this was that patients seen in specialist clinics could be seen by both consultants and junior hospital staff, and the junior staff had lower salaries than general practitioners with special interests.
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