Care closer to home – a changing role for physicians

Editor – I read Linda Patterson's editorial (Clin Med February 2010 pp 4–5) with great interest. I am pleased to see that general practitioners with a special interest (GPwSI) did receive a mention albeit a brief one.

There are several experienced GPwSIs working in my locality in the field of gastroenterology and endoscopy. In my view both hospital trusts and primary care trusts (PCTs) have failed to utilise this workforce effectively: they have, in effect, been regarded as ‘just another pair of hands’.

The government policy to deliver services closer to the patient's home is to be welcomed. There is now a new opportunity for PCTs to revisit service design which should permit GPwSIs (perhaps with nurse practitioners) to deliver clinical services from community premises. This would free up time for consultants to deal with bowel cancer screening as well as more complex and difficult cases. However, it is vital that GPwSIs liaise closely with consultant colleagues to ensure that the service design is sound and that the patient journey is appropriate and, above all, safe. Other issues such as training and governance need addressing carefully. The new GPwSI job description in endoscopy together with ongoing appraisal and revalidation (which is currently being developed) will look after this.

The new challenge therefore is not to deliver more of the same locally but to re-examine service design and use the available workforce more effectively. In doing so clinicians will work better together and their patients ultimately will get a better and timelier service.

• © 2010 Royal College of Physicians