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Develop your special clinical interest

As a GPSI you need a deep fascination with the speciality and supportive partners, says Jennifer Taylor.

Last December NHS Employers deputy director Sian Thomas cast doubts on whether there is a future role for GPSIs given perceived difficulties with developing revalidation of their skills.

However, GPs thinking about developing a special interest should not hang up their gloves as there is still plenty of action in the ring.

Pivotal role
Under government policy, GPSIs have a pivotal role in moving secondary care services into primary care via practice-based commissioning (PBC).

Indeed, the DoH has published an accreditation scheme for GPSIs, which can be found on its website.

The DoH has also commissioned the RCGP to produce specific competencies for the different special interests and so far, they have produced one for dermatology and skin surgery.

The RCGP is working on a list of others, including coronary heart disease, diabetes, mental health and respiratory medicine. The full list is available on the DoH site.

Dr Clare Gerada, vice-chairwoman of the RCGP, explains: 'It's not the training that's important, it's making sure you've got the right competencies.'

The College will not be recommending specific training courses, apart from its own certificate in substance misuse, so GPs should be wary of courses which claim to be accredited by the RCGP.

'My view is you can't go wrong by talking to your local acute trust specialist and saying "I'm interested in training as a GPSI, what do you suggest?",' she says.

Hospital specialists may recommend training and speciality funding options.

Choosing a speciality
Dr Gerada says primary care organisations (PCOs) or PBC groups may fund the training if there is a need for the service. Or the GP's practice may agree to pay for it.

Some PCOs have contracts with GPSIs and some PBC groups have service level agreements with GPSIs.

Specialities where GPSIs are in demand include community gynaecology, dermatology, musculoskeletal medicine, diabetes, headache and eye problems.

When choosing a speciality, Dr Gerada firmly believes GPs should only pick an area that they really want to develop expertise in. 'I don't think they should worry about what the market might need because I think it will change by the time the GPSI is ready,' she says.

However, she admits that the outlook is a bit uncertain.

'We're not 100 per cent sure where GPSIs are going, but clearly they fit into health minister Lord Darzi's model.'

She says GPs should not worry too much about whether there is a framework now to be employed in there chosen special interest.

'When I did substance misuse, there wasn't the term GPSI, nothing existed, I just did it because I was interested.'

Practice expert
She advocates making sure you are first a fantastic general practitioner then pursuing a specific interest.

'Once you've become competent, see how your skill fits in with what the health service looks like at that stage.'

When drumming up work, the options include being the practice expert, or the expert to a group of practices.

Dr Gerada highlights that in her area there is a musculoskeletal service, so other GPs can refer to the musculoskeletal GPSI. The service was set up through PBC.

Approach hospital
Another option is to approach your PCO or hospital for work.

'An acute trust might say, 'we want a GPSI in genetics to make sure GPs are skilled up in advising patients about common genetic disorders, in screening for common conditions, and providing family support'.

You need the backing of your partners. Dr Gerada says that partners are generally agreeable. At her practice, a salaried GP wanted to become a GPSI in diabetes, and the practice helped fund the training.

'When she finishes the training she'll be our resource. In time she may be the PBC group's resource.'

While there are concerns over competency, revalidation and accreditation Dr Gerada warns that if the system adopted is too rigid it will put GPs off pursuing their special interests.

In demand
Specialities where GPSIs are needed:

  • Community gynaecology.
  • Dermatology.
  • Musculoskeletal medicine.
  • Diabetes.
  • Headache.
  • Eye problems.

GPSI accreditation scheme at www.dh.gov.uk

Case study
Dr Elliott Singer's special interest in minor surgery developed out of a service need in the area. A GP in Chingford, London, his PCT in Waltham Forest wanted to move the carpal tunnel service into primary care. For all the normal lumps and bumps, having a GP with the right skills could reduce referrals to dermatology.

Dr Singer also performs vasectomies and obtained a diploma in local anaesthetic vasectomy from the Faculty of Family Planning before training to do carpal tunnel decompression operations. He now takes referrals from other local GP practices for a range of operations, including moles, cysts, lipomas, skin tags, carpal tunnel decompression and vasectomy.

'Before you even start you have to discuss it with your partners and make sure you have the support of the practice because without it, these things won't even start to get off the ground'. He says that the next steps are to formulate a business plan, make sure it is financially viable, and approach the PCT with ideas. For clinic-based specialities, such as diabetes, expenditure can be quite low, but for extended minor operations the GP needs equipment and an operating theatre.

'One of the problems for us locally is that budgetary constraints mean there is less and less commissioning of new services,' he adds.


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