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At the heart of general practice since 1960

Breath of fresh air

Becoming a GP with a special interest leads to a hugely rewarding and diverse career, writes Dr David Bellamy, a GPSI in respiratory medicine

Becoming a GP with a special interest leads to a hugely rewarding and diverse career, writes Dr David Bellamy, a GPSI in respiratory medicine

Respiratory diseases have long been a low-priority area of medicine to the Department of Health. Yet they kill one in four people in the UK, and account for more deaths a year than coronary heart disease.

Respiratory problems are the most common reason to visit a GP, and exacerbations of chronic obstructive pulmonary disease (COPD) are the most common cause of acute medical admissions. I have become a GPSI in this field, and although the work is time-consuming, I find it enjoyable.

The department did not include this specialty in the first group of clinical areas where GPs could assess and treat patients who might otherwise be referred to secondary care. Largely because of this, GPSIs in respiratory medicine are relatively few. The NHS Plan of 2002 initially proposed 1,000 GPSIs. The drive for GP commissioning may well accelerate the need for respiratory GPSIs, as one popular area of favoured clinical care is the improved management of patients with COPD and the reduction of hospital admissions with exacerbations.

The General Practice Airways Group (GPIAG) has campaigned to have a respiratory champion in every PCT. GP commissioning increases the urgency, as they are likely to be needed to organise and supervise the development of high-quality patient care in COPD.

Respiratory GPSIs may have differing roles dependent on local needs1.

  • Clinical role ­ activities include asthma, COPD and possibly respiratory infections and allergy. This role may involve seeing patients referred from other GPs with the agreed clinical protocols of local secondary care respiratory physicians. Within this remit may fall development of community pulmonary rehabilitation, intermediate care beds and palliative care. 
  • Education and liaison ­ helping colleag-ues to set up services relating to the quality framework. Teaching and developing spiro-metry services and locally agreed clinical care pathways. 
  • Service development and leadership ­ encouraging adoption of national guidelines and quality standards, PCT-wide diagnostic services, disease prevention .

The GPIAG and RCGP have drawn up recommendations for training, accreditation and maintenance of competencies1,2. MSc courses are available at a few centres but no accreditation by a diploma course exists. Most GPSIs will be appointed following experience as a clinical assistant/hospital practitioner in a secondary care clinic.

Hospital experience

I came into general practice in 1987, having spent many years training in respiratory and general medicine in hospitals. My training included research, particularly in asthma and COPD, and an attachment to the pulmonary function unit at London's Brompton Hospital. Contacts I made in secondary care were subsequently instrumental in my becoming involved in national guidelines committees.

When I decided to go into primary care I was determined to use my knowledge to best effect, and to help develop services locally and nationally. The GPIAG was being formed, and I became a founder member. Later, in the 1990s, I served on the steering committee and chaired the group for three years. Once I was established as an opinion leader in primary care, I received invitations and opportunities to take part in British Thoracic Society (BTS) guidelines on asthma and COPD, and later to contribute to NICE guidelines on COPD and lung cancer.

I had joined the BTS in 1977, and in the late 1990s was elected to serve on the standards of care committee and the COPD consortium, which produces educational materials for primary care.I also received opportunities to take part in advisory panels with the pharmaceutical industry, which often provided a forum to discuss research and help develop therapies.

Commissioning role

In the past few years I have become respiratory lead for Bournemouth PCT, and a role in commissioning is evolving. Part of my remit is keeping my knowledge up to date. I attend meetings in Europe and the US as well as BTS meetings, and read respiratory journals.

Taking part in BTS, GPIAG and guidelines work can be time-consuming. In the main I agreed with my partners that I would work my half-days to make up the time. I write and lecture in my own time. I spend about six hours a week on such activities. Remuneration for BTS and other charitable groups is on an expenses-only basis. I enjoy the work, however, and feel privileged to be contributing to the development of respiratory medicine in the UK.

David Bellamy is a member of GPIAG and respiratory lead for Bournemouth PCT

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