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Varying response to Government drive to shift work into primary care

Primary care organisations are taking starkly differing approaches to the development of GPSI services, a Pulse investigation reveals.

While some PCOs have pushed ahead with 50 or more GPSIs, others are yet to employ their first one, a survey of 44 areas has found. The findings suggest the Government's drive to shift work into primary care is stalling in some parts of the country through lack of funding or resistance from specialists.

The survey found an average of nine GPSIs per PCO, with 30 per cent employing 10 or more, but 26 per cent having only one or none. More than half of PCOs have a dermatology GPSI – the most popular specialism – with diabetes, ENT and musculoskeletal medicine GPSIs also common (see graph, above right).

The figures follow Pulse's revelation last week that as many as 43 per cent of PCOs have no formal system for accrediting GPSIs, raising concerns that some may be rolling services out too readily.

Bradford is one area that has fully embraced GPSIs, with a startling 90 holding a total of 175 accreditations.

Sue Nguyen, transitional director of diagnostic and treatment services at Bradford and Airedale PCT, insisted its accreditation system was robust and 'guarantees involvement and engagement with local consultants'. She said: 'We're paying for consultants to come and support, supervise, train and govern our service. If you don't have local consultant support, I don't know how you would proceed.'

Dr David Bellamy, a GP in Bournemouth and an adviser to his PCT on the development of GPSIs, said the trust was appointing GPSIs in orthopaedics, dermatology and diabetes 'as a drive to save money and cut costs, basically'. He added: 'In terms of provision, it really depends on local needs and local funding. In some parts of the country it is quite patchy.'

Professor Chris Salisbury, a GP in Bristol who led a study questioning the cost-effectiveness of GPSIs, said PCTs 'have to be clear about why they are introducing GPSI services'.

He added: 'In some instances it might be appropriate if there is no hospital nearby, but if they are just being introduced for financial reasons, there has to be some serious thought about the direction it's going in.'

Far ends of GPSI spectrum

Bradford and Airedale PCT

• 46 GPSIs providing services at three diagnostic and treatment centres • About 20 more working in general practic

• Variety of GPSI services – diagnostics, opinion-based or triage-treatment • Consultants involved from outset and are paid to train GPsFlintshire LHB

• Currently has no GPSIs • In process of reconfiguring dermatology services at North East Wales NHS Trust

• GPSI posts to be advertised shortly • GPSIs will work closely with consultants for the first year before moving out into primary care

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