This is partly because the DoH has not provided a clearly defined idea about the GPSI role; PCTs have been allowed to go their own way. As Dr Brian Malcolm points out on page 20, the government created the role then took years to work out what these doctors should be doing.

The result is that GPSI services across England are highly variable. Our investigation this week reveals that some PCTs have enthusiastically embraced GPSIs, using them to re-design services, while others have been uninterested.

In addition, almost a third of PCTs have yet to accredit all of their GPSIs and there is confusion about what standards should be used. In some specialties PCTs are left to decide on these standards themselves, which will inevitably lead to inconsistencies.

In the face of this variation it is, therefore, hard to gauge success.

GPSIs were initially seen as a key plank of the 'care closer to home' policy. The theory was that they would enable some people to be treated in primary rather than secondary care, which would be significantly cheaper and more convenient for the patient.

However, this theory has not translated into practice in many areas.

Last month, an Audit Commission report showed that PCTs were failing to transfer care from hospitals into community settings (GP, 20 November).

There are a plethora of reasons why this has not happened, but one of them must surely be a failure to invest in GP-led services, including GPSIs.

In some areas, GPSIs have proved their worth. The challenge now is ensuring that this good practice is spread to other areas.

GPSIs are not necessarily appropriate for every area, but PCT managers need to understand what these GPs are capable of and know how they can be supported to deliver new and successful services.

The RCGP says GPSI development has stalled. Perhaps the DoH should swallow its pride and ask the college to help put GPSIs back on track.