Gatekeeping is the term used to describe the role of primary care physicians or general practitioners (GPs) in authorizing access to specialty care, and diagnostic tests. Gatekeeping has crucial influences on service utilisation, health outcomes, healthcare costs, and patient satisfaction. 
It was developed as a response to a shortage of specialists and a desire to control healthcare spending and has been an accepted practice in lot of countries. Yet direct access could help reduce GP workload and facilitate greater patient choice. They look in this study at the pros and cons of gatekeeping policies in various countries, and highlight the need for more evidence to devise policy.