RCGP chair Dr Clare Gerada has criticised the use of GPs with a special interest to ‘mop up’ hospital activity and has called for a wholesale revamp of the programme to focus on reducing healthcare inequalities.
Her comments come as the RCGP prepares to release a series of recommendations on the future of the GPSI programme as part of its commission on generalism. Dr Gerada said GPSIs should be providing extra services in the community targeted at underserved groups, rather than replicating hospital services in areas such as ENT and heart failure.
But GPSIs in secondary care specialities defended their roles, claiming they provided a service which complemented that offered by their hospital counterparts.
Dr Gerada told Pulse: ‘The temptation is to create senior GP registrars in the community and badge them as GPs with a specialist interest. From the early days, there was a movement to create ENT GPs and all they were was fodder to mop up activity in communities – that is not what I want to see.
‘We have to tap into the GPs’ generalist skill and have GPSIs working in areas that hitherto do not necessarily fit – for example community gynaecology services, services for the homeless and those with learning disabilities – not just replicating hospitals.’
The comments have implications for the whole GPSI programme, as the RCGP develops competencies for GPSI accreditation alongside the Department of Health.
Dr Daryl Freeman, a GP in Mundesley, Norfolk, and a respiratory GPSI, challenged Dr Gerada’s comments and insisted her role was very different from that of a hospital consultant: ‘I think of myself as part of a community respiratory team. I think that’s complementary rather than mopping up consultants’ work.’
Dr Simon Tickle, a GPSI in mental health and substance misuse in Northampton, said he saw no problem in GPs acting as ‘mini-consultants’: ‘I provide a holistic GP-oriented primary care service for people with mental health and substance misuse problems, and I agree with Dr Gerada that this is an appropriate use of a GPSI.
‘But for GPs who are interested in doing more specialist work in dermatology or cardiology, that could be stimulating for their generalist work, as well as reducing waiting lists and making referrals cheaper.’
Role of the GPSI
• GPSIs should not have a ‘generic’ role and should be contracted to deliver a ‘clinical service within a defined patient pathway’
• Clarity about the nature of the service provided is ‘an essential precondition for successful accreditation’
• Accreditation of GPSIs is done by PCOs or SHAs who assess whether they meet the required competencies in RCGP and DH guidance
• The services within which GPSIs work should also be accredited.
Source: Department of Health. Implementing care closer to home. 2007