General Practitioners with special clinical interests: a qualitative study of the views of doctors, health managers and patients.
BACKGROUND
The difficulties with under-provision of doctors mean that alternative ways of providing services need to be developed. In the UK, some primary care doctors are now providing services traditionally only obtained through secondary care. The views of health care professionals, as well as patients, about these new services are currently unexplored.


OBJECTIVES
To study the views of a variety of doctors, health managers and patients concerning the development of General Practitioners with special clinical interests.


DESIGN
Qualitative using semi-structured audio-taped interviews.


PARTICIPANTS
Health Service Managers, General Practice Registrars (GPRs), General Practitioners (GPs) with no special clinical interest, GPs with special clinical interests (GPSCIs), consultants (from specialties with and without GPSCIs) and patients who had attended a GPSCI clinic.


SETTING
The North East of England.


RESULTS
A range of positive benefits was identified for GPs with special clinical interests including enhanced job satisfaction and possibly increased recruitment and retention for general practice. They were expected to decrease hospital specialty waiting times and may address previously unmet needs. Patients appreciated the requirement of appropriate professional skill mixes for less serious conditions. Personal aspects of care were important for patients. Outcome measures appeared poorly defined. Negative aspects identified included a deskilling of the general pool of GPs and an increase in workload by treating previously untreated conditions. A variety of challenges in establishing these services (in particular proactive development of GPSCIs in areas of need, accreditation and governance) were uncovered and some potential solutions discussed.


CONCLUSIONS
The impact of GPs with special clinical interests has not been studied in any detail, and measures of success for these schemes, where they exist, may fail to address the wide range of potential positive and negative effects. Their cost effectiveness has been questioned, and yet in the future more of these types of schemes seem likely. GPs with special interests may be part of an increasingly flexible career structure that sees GPs and secondary care doctors and consultants having much more interchangeable career paths. Patients' views on the services were generally positive.