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International Primary Care Association

Clinical Focus Volume 1 N3

IPCA Admin

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Over the last ten years there has been increasing interest in specialisation in primary care and general practitioners with special interests (GPwSIs) are here to stay. The NHS improvement plan states that a wide range of NHS services are to be delivered through primary care, with an emphasis on the increase in the numbers of practitioners with a special interest. There are a number of important issues surrounding GPwSIs that still need to be resolved in the coming years and many barriers that will need to be overcome regarding training, remuneration and accreditation. The whole process will inevitably become more formalised and this will be evolutionary not revolutionary and will require Primary Care Trusts (PCTs) and practitioners to be adaptable and to be prepared to cope with the changes. There is clear guidance on how to proceed and much helpful information is available. It will be important to evaluate existing schemes and to look for research opportunities, particularly in the areas of cost effectiveness and patient satisfaction.

“The biggest issue in the medical workforce over the next 2 decades will be the specialist-generalist debate” (Wanless Report, 2001).1 Healthcare delivery in Britain continues to change rapidly, with particular emphasis on provision of many services moving away from secondary to primary care. The NHS Plan proposed the establishment of 1000 GPs with special clinical interests by 2004, to reduce outpatient waiting times. A new intermediate level of specialist care, provided by a GP, or nurse specialty practitioner, is just one way in which the quality and accessibility of services may be improved.


Sarcoidosis, a systemic granulomatous disease, has a worldwide distribution. It commonly affects young adults and manifests with bilateral hilar adenopathy, pulmonary infiltration, reticuloendothelial involvement, eyes and skin lesions. Cardiac, central nervous system, gastrointestinal, and renal lesions are less frequent. Immunological alterations include peripheral depression of delayedtype hypersensitivity, imbalance of OK T4:T8 subsets, an influx of T4 helper cells and Th1 cytokines to the sites of granuloma formation, hyperactivity of B-cells, and presence of immune complexes.


As yet dental practitioners with special interests (DPSIs) have not established themselves as a functioning group within the dental primary care division. If some obstacles surrounding training, funding and registration can be overcome, the author hopes that more minor oral surgery procedures including the removal of lower wisdom teeth, currently now carried out in the secondary care setting, could be safely and effectively carried out in the general dental practice primary care environment.


The use of enhanced General Practitioner services such as those provided by General Practitioners with Special Interests (GPwSIs) are currently being promoted by Government policy in the United Kingdom. However their long-term future will depend on rigorous evaluation and the demonstration that they are both effective and efficient. This paper describes a framework for such an evaluation based on experience of assessing the effectiveness of a GPwSI primary care dermatology service in the north of England. The evaluation team needs to incorporate the views of key stakeholders and have a framework for collecting data. Clinical outcomes need to be measured to assess effectiveness. A clear action plan needs to be developed at the end of the evaluation to address any deficiencies identified.

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