GP with a special interest (GPSI) is a role that divides the healthcare profession. Some think it is a good idea while others would not refer to them. I have been a GPSI in dermatology for six years and it is something I have not regretted. It has provided me with a new professional challenge.
What is a GPSI?
A GPSI is a GP with qualifications and experience that allow them to be an independent practitioner in a particular specialty. The definition of what constitutes the qualifications and experience required varies across different specialties - see resources for the DoH guidelines.
A key issue is that GPSIs can practise independently and are not hospital assistants or specialty trainees. This is helpful because it allows more flexibility for service providers who do not need to provide consultant supervision in every clinic, although regular consultant contact and support is an essential part of governance arrangements. The downside is that the buck stops with the GPSI and for some GPs, this is significant.
I recommend checking the guidelines before embarking on time-consuming and expensive qualifications. One of the issues is the clinical experience required to become accredited as a GPSI. This can include attendance at 50 to 100 clinics and you also have to find a consultant willing to support you through the process.
Hospital trusts may not be welcoming because they might see you as someone they train who then goes off and works for a rival service. However, this is not always the case.
There is also the question of employment after qualification. There is little point in investing time and energy for some extra knowledge alone. I estimate that the cost for a dermatology GPSI to train is £16,500 - this covers the course, books and locum sessions for 50 clinics.
The NHS is always changing and ideas change with it. It is my impression that with a shortage of consultants in many specialties and the trend towards providing services in the community, employment prospects are good, particularly in specialties where there are few GPSIs, such as rheumatology, care of the elderly and sexual health.
Once you have decided to train as a GPSI, it is important to gain the relevant qualifications and experience. The diploma in practical dermatology, while not being impossibly difficult, was a challenge, particularly on top of the day job and a busy home life. However, studying and passing was satisfying.
Finding time to attend clinics is another challenge but learning new skills and mastering a specialty is enjoyable. General practice becomes less challenging over time so it may be possible to find time to take on extra training.
In a new specialty, one is constantly asking questions and researching. It sharpens the mind and I found it invigorating.
Finding a GPSI post is also a challenge. Many are not advertised - currently it is a case of asking PCTs and hospital departments what services are out there and approaching the service manager.
Some alternative NHS providers, such as social enterprises and commercial healthcare providers, also provide services. There are no set rates of payment for GPSIs and no national contracts, so it is up to you to negotiate payment.
Bear in mind that community services currently operate below tariff rate and it pays to do your homework as to what a provider gets per patient - from there it is quite easy to do the calculations.
You must also realise that many of these contracts will not include holiday pay, sick pay or pension, so all must be factored into the calculation.
Some contracts pay per session and others, per patient. Both have their merits, depending on your philosophy. The same is true in regard to your practice and how you work with your colleagues.
GPSIs are not consultants and you do have limitations. All GPSIs must have consultant support on a regular basis plus continuing education and appraisals, including audits. At first you find that you are frequently asking questions of your consultant colleagues as well as researching resources.
Over time, you will become more experienced and find that you ask your consultant colleagues fewer questions. I can now manage about 80 to 90 per cent of referrals competently without help.
As a GPSI you are in a unique position, because you understand the role of primary care and you have an insight into the dilemmas faced by specialists.
I found that most colleagues are supportive and the quality of referrals was generally excellent. Some GP colleagues will be happy to ring you about a case, which may not be true of a consultant colleague.
Patients like the service and some enjoy the kudos that their doctor is a 'specialist' too. The downside is that every patient with a particular problem seeks you out, especially in a large practice.
- Dr Charlson is a GP with a special interest in dermatology in Brough, Yorkshire
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