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The Government's drive to increase the number of GPs with a special interest could be a waste of NHS cash, leading academics claim.

A senior doctor who advised the NHS on setting up the scheme has also warned of future 'clinical and cost-effectiveness' problems because it is being abused by PCTs.

The cricitisms come a month after the Department of Health set a target for 53,000 more procedures to be carried out in primary care next year. The move would bring the number up from 3.7 to 10 per cent of all NHS procedures.

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said there was no evidence using GPwSIs or nurse practitioners was more cost-effective than sending patients straight to a specialist.

His comments followed research by the centre which concluded the policy of shifting more work into primary care could cause 'fragmentation, duplication and increased overall cost'.

Professor Roland, a GP in Manchester, said many patients ended up going to a specialist anyway. He said: 'There is a potential for lack of communication and we do not know that it is cheaper to send patients to them if they are going to end up going to a specialist anyway.'

The NPCRDC conclusions echo research by the University of Leeds (British Journal of General Practice, January 2004) which also questioned whether using GPwSIs was cost-effective.

Meanwhile Professor Ram Dhillon, an ENT consultant and clinical lead at the NHS Modernisation Agency, said PCTs had created some posts simply in order to hit Government targets.

Professor Dhillon, who ran the first training courses for GPwSIs in ENT, said: 'PCTs have created some posts they probably should not have done. They are meeting targets inappropriately, and the Government is quite happy as they are getting the numbers.

'Ultimately this is going to be a problem, whether it is

a clinical or cost-effectiveness issue.'

The NHS Plan called for 1,000 specialist GPs by 2004. There are now 1,500.

By Joanna


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