Professional development - How to become a GP with a special interest

It is a challenging career path but rewarding to develop specialist skills, explains Dr Louise Warburton.

The DoH definition of a GP with a special interest (GPSI), taken from the document 'Implementing Care Closer to Home Part 3', is a GP who supplements their core generalist role by delivering an additional high-quality service to meet the needs of patients.

Have a good grounding in general practice before becming a GPSI

GPSIs deliver a clinical service beyond the scope of their core professional role. They will have demonstrated appropriate skills and competencies to deliver those services without direct supervision.

Membership of the RCGP is stated as 'desirable' and is perhaps the most easily demonstrable core part of the role.

Experience is vital
I would strongly advise all GPs wishing to become a GPSI to have a good grounding in every-day general practice. It is not wise to set out on a career path in general practice with the aim of becoming a GPSI in as few years as possible.

The art of general practice cannot be rushed and all experience is vital to the role of GPSI.

I have been a GPSI for five years. I worked as a clinical assistant in rheumatology for 12 years before the role metamorphosised into that of a GPSI in rheumatology. As I can remember, the change was seamless and did not involve me having an interview or sitting any exams.

The change of responsibility was challenging but I was ready for it and I enjoyed the extra clinical role. I had my own case-load of rheumatology patients and could manage them without seeking help from the consultant in clinic, unless I needed it.

I am now a GPSI in musculoskeletal medicine as well, and in this role I work in isolation from secondary care, as part of a team of physiotherapists and extended-role physiotherapy practitioners.

DoH pathway of individual doctor accreditation

The doctor must:

  • Demonstrate appropriate levels of skill and competence to fulfil the role described (probably a postgraduate diploma in the relevant field).
  • Demonstrate a clear understanding of the key role the GPSI is being asked to fulfil.
  • Understand the appropriate clinical pathway.
  • Understand and participate in the clinical network in relation to the clinical pathway.
  • Set out commitment to ongoing training, updates and education through appropriate appraisal and a personal development plan.
  • Make appropriate indemnity arrangements.
  • Make appropriate peer review and mentoring arrangements.
  • Demonstrate how the role fits the existing portfolio.
  • Provide evidence of professional registration and recognition on a PCT performers list.

Postgraduate diploma
To challenge myself and to improve my knowledge of medical orthopaedics, I recently obtained a diploma in musculoskeletal medicine. I have just finished the two-year course, run by the British Institute of Musculoskeletal Medicine. I could also have chosen the diploma in primary care rheumatology from the University of Bradford.

A postgraduate diploma is almost mandatory in the current climate. Otherwise, a candidate must provide evidence of their specialist training and skills.

With the introduction of the DoH document on accreditation of GPSIs, I think the process of becoming a GPSI will become more rigorous.

The DoH document provides a pathway of individual doctor accreditation (see box).

This list of requirements will be vetted and the individual doctor will be interviewed by a panel comprising a lay member, a senior commissioner, a senior representative from the professional executive committee or GP representative of the RCGP, and a senior clinician from the relevant specialty, before they can become a GPSI.

This is separate from service accreditation, where the service in which the GPSI is working must also be vetted by a panel of accreditors.

Clinical pathways
Most PCTs will help to design the service the GPSI will provide and the clinical pathways.

The Map of Medicine and the NHS 18-week website have many resources and clinical pathways that have already been validated.

The care pathways in the service are open to scrutiny and all must be watertight.

The process is by no means easy or rapid. It demands clinical competence and commitment. Do not take on the role lightly.

It requires a great deal of work to become a GPSI and a lot more to maintain one's skills. But it can provide motivation in the workplace and allow GPs to develop their specialist skills.

  • Dr Warburton is a GPSI in rheumatology and musculoskeletal medicine in Ironbridge, Shropshire

Starting the process

  • Speak to a local GPSI, especially one in your field of interest.
  • Join national interest groups for guidance, support and education.
  • Speak to your local PCT service improvement team, which will be aware of population needs and any financial support that is available.
  • Look for suitable diploma courses in your field of interest.



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