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International Primary Care Association

Clinical Focus Volume 1 N1

Volume 1 Issue 1 - 2005

“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.


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.


Most of us consider Negotiation as something that happens only when buying a house or a new car: one argues in a “traditional” way offering less than one is willing to pay, trading concessions for concessions - grudgingly, in the hope of shaking hands on a reasonable price in the end. When the deal is done, the parties involved rarely feel happy.


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