The system, launched by the DoH earlier this month, aims to bring all GPSIs up to a single national standard (GP, 4 May).
But individual PCTs will make the final decision on whether to accredit GPs in their area. As a result, GPs fear that PCT commissioning, rather than national standards, will count most for GPSI accreditation.
Under the system, GPs must attend an RCGP-approved course and prove their commitment to the specialty and their generalist position, before a panel at the local PCT decides whether the GP and their service should be accredited.
DoH national clinical director of primary care Dr David Colin-Thomé, who was involved in drawing up the plans, admitted that passing GPSI accreditation in one PCT did not mean automatic GPSI status in other PCTs.
‘It’s not a portable degree,’ he said. ‘We want PCTs to take the responsibility, but often the DoH can provide the framework.’
GPC negotiator Dr Richard Vautrey said: ‘There is certainly the opportunity for PCTs to do different things as to how they operate it. It’s likely to put off significant numbers of GPs from becoming GPSIs.’
At a time when the DoH is shifting work into primary care, he said this was a ‘major barrier’ to developing GPSIs to do the work.
Dr John Haughney, a Glasgow GP who has a special interest in respiratory diseases, said: ‘There will be lots of competent GPs who would want to be a GPSI but wouldn’t want to be jumping through these hoops.’
Professor Ram Dillon, member of the Association of Practitioners with Special Interests and an ENT consultant at Northwick Park hospital in north London, said national accreditation was needed, but current plans were flawed. ‘If Dr Colin-Thomé says they have to be accredited locally, then it’s not a national accreditation system.’
Accreditation should be transferable between PCTs, added Professor Dillon.
‘If you’re going to have a lot of mobility of GPs — and that’s likely to be the case — you’re going to have PCTs reconfiguring these assessment groups,’ he said.
Dr Colin-Thomé said practice-based commissioning would allow GPs to influence GPSI services in their area.
But Shropshire GP Dr Louise Warburton, a GPSI in musculoskeletal disease, said this could also threaten GPSI development because some GPs were opposed to specialisation.
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