We need GPSIs for truly joined-up care
The overlap between primary and secondary care is now well-established, so the changes to the use of GPSIs are very welcome, says Dr Hamed Khan
GP trainees are generally very positive about the concept of specialism, and most I've encountered are very keen to find out about the opportunities available to train and work as GPSIs.
From a personal professional developmental perspective, they see it as something that adds variety and depth to their everyday work of general practice, whilst helping them develop new skills. Although we train to be generalists, most trainees and newly qualified GP's have a specific inclination towards a certain speciality, either because they have had years of experience working in that area of medicine, or because they are simply fascinated by it.
Training and working as GPSIs gives trainees and new GPs a unique opportunity to spend time working in that speciality, developing their skills in that area in a way that is structured and supervised and allows them to be critiqued and appraised.
Beyond personal goals, they see their roles as vitally important for patient care in the current state of the NHS.
The trend to move care from hospitals into primary care and the community is well established, as it is not only cost-efficient but also leads to a better quality of care and patient experience (as most patients prefer to not be admitted into hospital).
This has created a broad area where primary and secondary care can overlap and work in a collaborative and complimentary way- such as where hospital specialists run clinics in the community and are supported by GPSIs with specific training in that speciality. This model is used fairly widely for specialities such as endocrinology, rheumatology, cardiology and dermatology.
I work in a large practice with a number of GPSIs and we have a large number of consultants coming to do clinics in our practice. It is clear that the consultants value the work of GPSIs, especially with respect to the generalist skills that they have, and the unique knowledge and familiarity that they have with the community. Unlike hospital doctors we do home visits and have an insight into the psycho-social factors affected by their home setting.
Most trainees and newly qualified GPs would agree that it is of paramount importance to ensure that gaps in community care (such as care for vulnerable communities) are filled, and would support any initiative to do this.
At the same time, the input of GPSIs to collaborate with their secondary care colleagues is also vitally important.
Most trainees are very positive and enthusiastic about GPSIs getting involved in hospital/secondary care activities and moving them out into the community/primary care setting. They view it as something that is not only beneficial for their own professional development, but also vital for sustaining and improving patient care- especially in the current financial state of the NHS. Consultants also see GPSIs as doctors who not only assist their work, but also who have unique skills in providing care in a holistic way and an insight into how they live in their homes and communities.
If the GPSI role expands and becomes enhanced, primary and secondary care will finally work in a truly 'joined up' manner that complements both sectors.
Dr Hamed Khan is a GP in Oxted, former chairman of the London Deanery GP Training Committee and the deputy representative for London trainees in the national RCGP AiT committee.