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GPSI accreditation system branded 'unfit for purpose'

By Nigel Praities

Government plans to accredit all GPSIs by next month's deadline are descending into farce, experts are warning.

Guidance published last week and circulated to PCTs only in January lists competency frameworks for 18 different specialist areas, including endoscopy, cardiology, diabetes, epilepsy, and headache.

But Pulse has learned that GPSIs are facing a mountain of red tape, including meeting more than 2,000 competency markers, that could discourage some from continuing with their special interests, and trusts are struggling to imeet the rush to implement the accreditation system effectively.

The push to meet the 31 March deadline comes as a top primary care expert raised doubts over the whole accreditation process, saying it would ultimately undermine faith in GPSIs as PCTs did not have the experience to assess clinical competence.

Dr Raj Dhumale, president of the Association of Surgeons in Primary Care, warned accreditation could do more harm than good and would do nothing to counter recent negative publicity surrounding the quality of GPSIs minor surgery.

‘This may make things worse. [The procedures] are very vague and subjective and it is going to be quite difficult to really have a uniform system because there are lots of people offering lots of different kinds of services.

‘There may be there lots of very good doctors out there doing surgery, but they might no be very good at record keeping.'

Dr Dermot Ryan, a GPSI in endoscopy in Loughborough, Leicestershire, said his PCT had initially not prioritised accreditation, leading to a huge last-minute rush.

‘In common with much NHS governance processes, it appears to be unrealistic, unwieldy, overly bureaucratic, ill thought out and generally not fit for purpose,' he said.

PCTs can choose which competency markers are suitable for the service their GPSIs provide and require GPs to provide evidence of expertise through a combination of clinical audits, case note reviews, reports from colleagues or log-books.

Dr Rupert Jones, a GP in Plymouth, said his PCT had rushed through accrediting him for respiratory medicine, with the whole process requiring a ‘pretty intense' day of unpaid work.

‘To a certain extent I welcome it, but as usual it is over the top. I see it as a barrier for an enthusiast who is busy – just one more bloody thing to do,' he said.

GPSIs in endoscopy face a rush to meet the accreditation deadline GPSIs in endoscopy face a rush to meet the accreditation deadline What GPSIs have to do

- GPSIs have to demonstrate they have completed recognised training, which may include previous expertise
- Assessment of competency can be done through a combination of audit data, case note reviews, reports from colleagues, log-books or role-plays
- Primary Care Contracting provide guidelines in many clinical areas with lists of clinical competencies PCTs can choose to measure
- GPs providing specialist services or clinical leadership with in their practice or PCT, do not have to be accredited if they don't consider themselves to have a specialist interest

Source: Primary Care Contracting February 2009, guidance and competencies for the provision of services by practitioners with a specialist interests

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