General practitioners with special interests: evolution and evaluation.

General practitioners with special interests (GPSIs) have emerged in the UK as a government initiative aimed at improving access in specialities that traditionally have long waiting times for investigations and treatment. This represents, to some extent, a formalisation of existing working practices of general practitioners who had obtained specialist experience during hospital training. GPSIs are working in a wide range of clinical areas including coronary heart disease, drug abuse, echocardiography and sexual health. Similar changes at the primary-secondary care interface are taking place in other European health systems. Key issues in the development of these services include the assurance of high-quality health care, clinical governance and risk management, cost-effectiveness and impact on outpatient care, and the work and role of specialists. It is possible that these new opportunities for general practitioners and other health care professions will aid recruitment and retention of staff in primary care, enhance education and encourage commissioners of services to look carefully at unmet needs in their health economies. Further challenges include the need to train a cadre of practitioners and to provide the research evidence on which to base continued investment in this promising initiative.