A key pledge of the NHS Plan was to establish 1000 specialist GPs by 2004. Behind this intention is the general move to encourage role diversity and more flexibility in working practices in the NHS - leading, we hope, to new, more effective ways of serving patients.
The term ??specialist GPs? has now been replaced by ??GPs with special interests? (GPwSIs), the RCGP with others having successfully argued that GPs are in fact specialists in the discipline of general practice/family medicine. GPwSIs are therefore clinical generalists, based in the community, with a special clinical interest in a particular field of medicine.
Primary care trusts will play a major part in implementing the NHS Plan?s undertaking, as they will employ or contract GPwSIs to deliver their services. PCTs will consider whether the establishment of a GPwSI service will enhance clinical provision in a specific field.
In general, there will be three different types of GPwSIs. There will be those doctors who will practise in a specific clinical area at a more advanced level than is normally possible in routine general practice. For example, where there are national clinical priorities such as those contained in national service frameworks, GPwSI services could make significant contributions at a local level.
Other critical areas to benefit from enhanced service delivery are those covered by the Department of Health?s Action On Programmes, such as Dermatology, ENT and Orthopaedics. GPwSIs will also be involved in carrying out procedures usually undertaken in secondary care, such as endoscopy or echocardiography. In addition, GPwSIs could also act as lead clinicians in PCTs in areas such as cancer services, emergency networks and child protection.
The NHS has only two grades of doctor qualified to work in an unsupervised capacity when caring for patients -these are consultants and GPs. Therefore GPwSIs will normally work independently, within a framework of clinical governance and accountability to the PCT.
GPwSIs are not ??cut-down specialists? but expert generalists providing services at an advanced level. They will be expected to work within their level of competence (in itself, a key skill of the generalist), and to know when a patient should be referred to a specialist. The guiding principle must be that patients who are treated by a GPwSI will be guaranteed care of the same quality as that which they would have received from a specialist.
To help PCTs implement GPwSI services, guidance has been issued jointly by the Department of Health and the RCGP, and this can be found on the DoH website: www.doh.gov.uk. The guidance sets out the principles relating to GPwSIs and covers areas such as training and experience, clinical governance and relationships with secondary care providers.
As PCTs start to scope the potential for these services, it will be interesting to note what they wish to commission and the ways in which patients can be helped to gain access to services more conveniently and appropriately. There will be much to learn from this development, and undoubtedly implementation will evolve and improve with time.
For now, GPwSI services are an interesting development with the potential to add variety and satisfaction to the working lives of GPs, to help in implementing the NHS modernisation agenda, and most importantly, to improve care of patients.