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Objective and study design: to assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost‐ effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six‐month cohort of all referrals (November 1996‐April 1997). Subjects: all referrals for suspected cancers of: upper gastro‐intestinal tract; urinary tract, prostate and testis; skin. Effectiveness: median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. Results: GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. Cost‐effectiveness: extra (incremental) NHS cost per patient diagnosed. Results: Less than £5 per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than £3 per day saved between GP referral and consultant decision for: testicular; haematuria. Less than £3 per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. Conclusion: A “quick and early” diagnostic route provides a higher quality service through improved effectiveness and cost‐effectiveness compared to conventional outpatients.

Rheumatoid arthritis is a common chronic disease associated with significant morbidity and mortality. As with all chronic conditions, active participation by the patient, in areas ranging from accepting the diagnosis and its treatment to the implementation of coping strategies, is essential for effective management. Involving any patients in these process can be difficult; however patients of South Asian origin can present particular challenges. Many patients of South Asian origin have beliefs about disease causation and the utility of pharmacological and non‐pharmacological treatments that differ from those held by other patients. Communication difficulties can make it difficult for health care professionals to address these issues. We discuss strategies to support patients and encourage their involvement including linguistically appropriate educational material, peer support and telephone helplines.