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In February 2009, the Department of Health published revised frameworks for practitioners with a special interest (PwSI), replacing the frameworks for GP’s with special interests (GPwSI) published more than 5 years ago.

The name “practitioners” has been used as the documents include pharmacists, but not nurses who are covered by separate frameworks for advanced nurse practitioners. The BGS and the RCGP assisted with the creation of this latest guidance on PwSI for Older People.

There are relatively few GPwSI for Older People in the UK at present, although far more GP’s are actively involved in the delivery of specialist services such as Intermediate Care, Community Hospitals, specialist clinics and Day Hospitals. The framework describes potential competences for PwSI’s, and the expectations for establishing and maintaining competence. Commissioners are also advised to commission services where the facilities are accredited. “The guidance relates to the specific training and accreditation needs of general practitioners seeking accreditation as PwSIs in Older People. The competency framework is designed to help practitioners understand and develop the extended knowledge and skills they will require to provide services beyond the scope of their generalist roles.” It is intended that a specific service should identify the competencies appropriate to the delivery of that service, rather than expecting a PwSI to have the full range of competencies listed.

Considerable emphasis is placed throughout the document on the importance of direct access to supervision from specialists, usually consultants, for their clinical work and also for their clinical governance and continuing education. It is easy to take for granted the contribution made by GP’s to our services, and this framework emphasises the responsibilities on both the PwSI and the supervising consultants. It is therefore important that consultants should read this document, and use it as a stimulus to establishing, or re-invigorating, effective clinical governance structures within their services such as Day Hospitals or Community Hospitals.

Separate sections of the document deal with the infrastructure required for the service, the competency framework, teaching and learning, assessment to prove competency, accreditation and re-accreditation. While this may appear overwhelming or bureaucratic to some, it provides a roadmap for developing the skills of GP’s already involved with our services, and a curriculum for those expressing an interest in our specialty.

I hope that this document will encourage more GP’s to consider becoming a PwSI for Older People, and that the clinical governance structure of our services will be stimulated to respond to the standards described in the framework.

The guidance can be downloaded here.

Ian P Donald
Chair of working party “Practitioners with Special Interest for Older People”, on behalf of the Royal College of General Practitioners and Department of Health

BGS Newsletter, March 2009
Issue 21 ISSN 1748-6343 21