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Independents' Day

GPs with special interests are very much here to stay

Under the new contract the number of GPs with special interests is likely to increase ­ Dr Sohail Butt looks at what these GPs have to offer and what becoming one entails

The new GMS contract allows GPs to employ salaried doctors, nurses and non-medical staff to take on the care of stable chronic illness. This frees GPs with a special interest (GPSIs) to develop GPSI roles.

There are many advantages to becoming a GPSI. The work gives variety to a GP's weekly schedule and there is the challenge and educational potential that working in a specialty offers. GPSI work also opens the door to additional income from lecturing, pharmaceutical company work and in some cases private practice.

Another advantage is that practices benefit from the kudos of having specialist services. Also a direct relationship is forged with the PCT. The experience in my practice has been very positive. One of our partners, who had a longstanding interest in dermatology, was approached by the PCT to set up a GPSI clinic in dermatology at the practice. The service started a few months ago. I have had upbeat feedback from patients who enjoy seeing a GP specialist in primary care, and it appears to have reduced the wait for dermatology appointments.

What should you do if you want to develop a special interest?

There are currently about 16 specialties worked by GPSIs, including ENT, orthopaedics, cardiology, diabetes, substance misuse, neurology, sexual health, dermatology, endoscopy, palliative care, older person care, mental health, respiratory medicine, ophthalmology and urology.

If you want to become a GPSI the first thing to do is to look at local need ­ this may be obvious to you from knowledge of long waiting lists or delay in accessing certain services.

It is worth discussing matters with your PCT development manager to see in which areas it feels there is a need. The PCT may support you with training and negotiation with secondary care providers. There will have to be agreement between yourselves and the consultants for the service to be a success. Ideally there should be some joint working with the consultant, at least once a month, and attendance at the specialist audit meetings.

There are various postgraduate training courses in the different specialties and the possibility of in-house training. Some GP registrars are now offered the possibility of extended training for six months after their one-year GPR training. This usually takes the form of four sessions as a GP and four in a specialty of their choice. This can be a good grounding for future GPSI work.

What issues will I need to look at?

You will need to decide where you wish the clinics to take place, and whether you have the space at the practice. You will need to look at any start-up costs for equipment and training and agree funding with the PCT.

There may be additional staff and administrative costs to run the service which will need to be factored into the remuneration.You will need to negotiate an increase in your prescribing budget if a rise in prescribing costs is expected. You will need to inform your defence union of your new role.

Indeed, if there is a pitfall to being a GPSI it is that there is a significant amount of work involved in planning, costing and agreeing the service with the PCT and consultants. Remember, too, there are no nationally agreed levels of pay so you will need to negotiate well to achieve reasonable levels of remuneration and terms and conditions.

The future of GPSIs

The Department of Health is keen to keep patients out of hospital by developing the roles of GPs. The development of more GPSIs breaks down the interface between primary and secondary care and allows the department to develop integrated services across specialties.

It is likely this will reduce waiting lists and improve access to specialist services, in particular for those patients who would previously have been referred to secondary care. The future of GPSIs looks bright ­ they are here to stay.

Sohail Butt is a GP in Ashford, Middlesex

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