Study of direct listing for tonsillectomy by General Practitioners

Abstract

The aim of this study was to determine the viability of direct listing of patients with recurrent acute tonsillitis, by their General Practitioner (GP), onto the tonsillectomy waiting list. All the GPs in the area served by North Staffordshire NHS Trust were informed by letter of the existence of a direct access tonsillectomy service. They were issued guidelines with strict inclusion and exclusion criteria. The inclusion criteria were: (1) three or more attacks of recurrent tonsillitis each year; or (2) symptoms for 2 years or more. The exclusion criteria were: (1) children below 8 years (chosen as a cut-off point so as to reduce the number of patients who also had otitis media with effusion [OME]); (2) snoring or adenoidal symptoms; (3) previous quinsy; or (4) hearing loss. GPs were requested to complete a form detailing the specific indication for tonsillectomy by direct listing. The patients were then screened in special clinics by the same otolaryngologist to assess suitability for direct listing. One hundred patients were referred for the direct access tonsillectomy service over a 6-month period. Thirty-three were inappropriate; 19 patients did not have the required number of attacks of acute tonsillitis; 11 were under the age of 8 years; and 34 had OME and hearing loss. The high rate of inappropriate referrals (33%), despite issuing GPs with strict guidelines, makes this an unacceptable practice.