The opportunity to develop additional knowledge and skills and to be recognised as having extended roles offers an element of career development that is valued in general practice and recognised as one of the benefits of being a GP.
In 2000 the NHS plan proposed a new role - the GP with a Special Interest (GPwSI), who would work as part of locally integrated services. Dermatology has been at the forefront of the development and implementation of this role.
Since 2000, there have been several iterations of accreditation guidance in dermatology to ensure that patients seen by GPwSIs receive high-quality care. Accreditation has usually been delivered locally and the previous guidance was published in 2011.
One of the main challenges to the further development of GPwSIs has been a lack of consensus on how to accredit individuals. So, following a period of collaboration between the RCGP, British Association of Dermatologists and the Primary Care Dermatology Society, it was agreed that accreditation should be underpinned by a national process delivered by the RCGP.
The RCGP had adopted the term GP with extended role (GPwERs) for those with significant roles outside of core general practice, including those formerly referred to as GPwSIs, and an accreditation pilot for GPwERs in dermatology began in June 2018.
GPs with extended roles
Extended practice is defined as:
- an activity that is beyond the scope of GP training and the MRCGP exam, and that a GP cannot carry out without undertaking further training, or
- an activity undertaken within a contract or setting that distinguishes it from standard general practice, or
- an activity offered for a fee outside the care provided to the registered practice population.
Additional factors may extend the definition:
- a GP receiving referrals for assessment and treatment from outside their immediate practice, whatever the practice’s patient list size
- a GP undertaking work that currently attracts an additional or separate medical indemnity fee.
GPwERs are first and foremost GPs with a UK licence to practise that continue to practise in core undifferentiated general practice.
Given that prior accreditation of GPwSI was so varied, NHS England and all stakeholders agreed that all GPwERs should be offered a new process to attain a nationally-recognised accredited status. However, in the dermatology pilot, this process was simplified for those who had previously been formerly accredited, which means that those GPs are not required to have their competencies reassessed.
The RCGP accreditation framework
An oversight group, which was established to oversee national accreditation, produced the RCGP Framework to support the governance of GPwERs.
Some the key features of the new framework include:
- The process of accreditation is about individual GPs and not the premises in which they work. Once an individual has been accredited they can take this with them if they move around the UK.
- The framework is intended to support GPs in all four nations and sectors of the UK, including those working outside the NHS.
- There is no longer a minimum number of sessions required to complete training, instead it is competency based.
- The mentor (senior clinical supervisor) had previously only been allowed to a consultant, now the mentor can also be an RCGP-accredited GPwER or associate specialist in the relevant scope of practice.
- RCGP accreditation is a one-off process - there is no need for reaccreditation.
- GPwERs are encouraged to participate in an annual specialty performance review in their extended role, which is fed into their whole scope of annual medical appraisal.
Following this work, a framework was developed for accreditation of dermatology GPwERs – the first specialist group to undergo the RCGP accreditation process.
The framework defines three groups of dermatology GPwERs:
- GPwER in medical dermatology: the diagnosis and management of inflammatory skin disease and the diagnosis and non-surgical management of skin lesions
- GPwER in skin lesion management: diagnosis and management of skin lesions, usually including low-risk BCC, using both surgical and non-surgical methods
- GPwER in medical dermatology and skin lesion management: undertakes work in both of the above groups.
Stakeholders agreed that there were significant differences between a GP providing a commissioned skin surgery/minor surgery service (such as under a DES or LES contract) and a GPwER.
GPs providing surgical services manage benign skin lesions and small low-risk BCC beneath the clavicle. They are first and foremost surgical services. GPs would be expected to have an understanding of lesion recognition appropriate to their surgical remit, but they have not undertaken specialist training in skin lesion recognition and management. These services only cover clinical remits within the normal scope of general practice; as such the RCGP does not consider such roles warrant extended role accreditation.
GPwERs work as an integrated team with commissioned secondary care services. They have undertaken formal specialist training and assessment in the diagnosis (clinical and dermoscopic) of skin lesions, enabling the GPwER to be commissioned to provide skin lesion clinics (excluding two-week waits).
Groups 2 and 3 GPwER as described above can also provide surgical services with a wider remit, which may include certain BCC on the head and neck. The remit described is broad and so formal accreditation is required.
The process of RCGP national accreditation of GPwERs involves completion of competency-based assessments and other relevant documents (see the RCGP website here for more details), followed by an assessment of the submitted paperwork by both a generalist and specialist assessor trained in this role. Their recommendation is then passed to the accreditation panel for final approval.
While membership of the RCGP is encouraged, it is not mandatory for accreditation or access to the relevant documents.
Moving forward the RCGP is reviewing requests from several speciality groups to develop speciality specific frameworks for new groups of GPwERs.
- Dr Tim Cunliffe is RCGP Lead for the National Accreditation of Dermatology GPwERs
- More information about the RCGP’s GPwER programme can be found here.