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GPSI: first-class GP not second-class specialist

From Dr Lewis Miller

Belfast

Further to your editorial, 'Accreditation long overdue' (Comment, 13 July), there are problems with GPSIs – and I speak from experience.

GPSIs have an anomalous position. By definition they restrict their specialist work to a segment of specialist practice. While doing this they work to the direction of a consultant.

It is possible to confuse their role with that of juniors, perhaps registrars or hospital grade practitioners, rather than that of equal colleagues. However, GPSIs are different from either group and should be regarded separately.

It is harder to be a good general practitioner than a good specialist. This is because the range of medical problems presented to GPs is much wider than to specialists and because having to consider all of the relevant medical, social and psychological variables adds many layers of complexity to our work. GPSIs don't have to cover the whole range of a specialty. What they have to do is become expert in part of it.

The cynic, or perhaps the realist, might say that all GPs have their own special interests even if it is only to maximise income or leave the premises first after a clinical session!

This is why partnerships are usually more productive than singlehanded practice. Young GPs are better at emergency medicine and medical technology, while maturity often brings greater expertise in managing complex psychosocial situations.

I wonder about the 'tough new system of accreditation' planned for the next generation of GPSIs. It is important to remember in this context that GPSIs are not trying to become specialists but to perform a limited range of specialised medical procedures to a high standard as GPs.

In theory they should be assessed by their peers, other GPSIs, rather than by specialists, although in practice this may be difficult until a critical mass of GPSIs evolves. In the meantime, GPs might assess their performance as well as specialists.

All patients deserve best care. All senior doctors, GPs, GPSIs and consultants should strive to deliver this and to develop ways of confirming that this is what they deliver. GPSIs must guard against being seen as second-class specialists rather than first-class GPs.

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