GPSI reaccreditation roll-out chaos threatens future of specialist GPs

The process for reaccreditation of GPSIs is 'muddled' and descending into chaos. Tom Moberly reports.

GPSIs fear that the reaccreditation process may be led by the wrong people (Photograph: SPL)
GPSIs fear that the reaccreditation process may be led by the wrong people (Photograph: SPL)

The chaotic roll-out of GPSI reaccreditation is threatening to undermine the advantages specialist GPs can bring the NHS, experts have warned.

GPSI roles were designed to build tiered layers of specialisation across primary and secondary care. After accreditation was introduced in 2008, rigorous standards were meant to be in place to ensure GPs delivering advanced services warranted the label 'GPSI'.

But implementation by PCTs of the original accreditation process was patchy.

GPs are now reporting that those failures are being repeated in a 'messy' and 'muddled' reaccreditation process.

Primary Care Rheumatology Society president Dr Louise Warburton, a GPSI in rheumatology and musculoskeletal medicine, fears the GPSI reaccreditation process may be led by the wrong people.

'It is usually a consultant and a panel of PCT representatives,' she says. 'Working in an interface musculoskeletal service is nothing like working in secondary care rheumatology or orthopaedics and a consultant can't always assess a GPSI properly.'


Dr Warburton: National guidance on reaccreditation would be nice. At the moment nothing is happening to take this forward

Dr Martin Johnson, a pain management GPSI in Barnsley, says the process of reaccreditation was 'very confusing'. 'As unofficial primary care lead for pain locally, I keep being asked what competencies people need. But there is no definable standard.'

Reaccreditation 'muddle'

Dr Stephen Hayes, a dermatology GPSI and hospital practitioner in Southampton, and a trustee of the Primary Care Dermatology Society, says reaccreditation is a 'muddle'.

'We know how a GP and a consultant are trained,' he says. 'We know exactly what they have to do. With GPSIs it has never been worked out, so training is being delivered in an irregular manner.'

The lack of guidance is leading to 'bizarre' local hearings.

Dr Matthew Fay, a cardiology GPSI in Shipley, West Yorkshire, says: 'I have recently been reaccredited by our somewhat draconian process in Bradford, where I was the first applicant for reaccreditation, without any cardiac expert on the panel.

'Then, bizarrely, I crossed the table to be the expert for the next candidates. The first of which was a close personal friend and a colleague at the cardiology service owned and run by my partnership. I obviously declared my conflict of interest.'

FALTERING ROLL-OUT OF GPSI ROLES

April 2007

  • Launch of frameworks for roles of practitioners with a special interest (GPSIs and pharmacists with a special interest).

June 2007

  • Directions for accreditation come into force.

September 2008

  • GPs need to be assessed by primary care organisations to continue to practise as a GPSI.

March 2009

  • PCTs expected to have accredited all GPSIs.

December 2009

  • GP reveals a third of PCTs missed GPSI accreditation target.

March 2012

  • Deadline by which all GPSIs should have been reaccredited.

Dr Hayes says that GPSI reaccreditation is one of a long list of programmes that have fallen behind as PCTs concentrate on NHS reforms. 'The present reorganisation is getting so complicated and it has created a planning blight,' he says.

Clear national guidance on how reaccreditation should work would be helpful, Dr Warburton says. 'National guidance on reaccreditation for each specialism would be nice. At the moment nothing is happening to take this forward.'

Extending guidance

Extending guidance to cover more than just GPSIs could help build this national standard, some GPs believe.

Dr Fay points out that original accreditation guidance developed by NHS Improvement was aimed at 'practitioners' with a special interest, covering not only GPs but also pharmacists and other health professionals.

He warned that relying on GP organisations to develop guidance may be unwise because the advice would only apply to GPs. Specialist primary care groups can only develop guidance in their own area of interest, which could lead to variable standards across specialisms, he added.

Meanwhile, primary care groups are facing funding threats, as the closure of the Primary Care Cardiovascular Society earlier this month revealed.

Dr Hayes wants a pragmatic approach. 'There are so many problems all over,' he says. 'Most could be solved by good faith and common sense, but those are rare qualities.'

But Dr Mark Dancy, now national clinical chairman for heart improvement at NHS Improvement, is optimistic. Dr Dancy, who was involved in the development of the original accreditation process for GPSIs, says: 'I think the Health Bill is going to be another fillip for GPSIs. A lot of areas are going to be looking at how they can expand services provided in primary care. I think GP commissioning will be really interesting if it's taken up, because it will lead - for the first time - GPs to look at other GPs' work.

'When commissioning secondary care, GPs will think "What can primary care do?" and secondary care is what is left. Then primary care becomes a service, rather than a whole lot of businesses.'

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