Career Development: General Practitioners with Extended Roles
Role of a GP and a GPwER
The role of a general practitioner is to treat all common medical conditions and make referrals to hospitals and specialist services where urgent and/or specialist treatment is required. GPs combine physical care with psychological and social aspects to treat their patient more holistically.
GPs with Extended Roles, GPwER for short, still fulfil primarily the role of a general practitioner as described above, and they still approach their patients in the same holistic manner as any other GP, but they bring additional insight, knowledge, and skill of their extended specialty to further improve care for their patients.
A GPwER is defined, according to the GPwER framework published by Royal College of General Practitioners (RCGP) as a GP who undertakes an extended role “within a contract or setting that distinguishes it from standard general practice, and/or is an activity offered for a fee outside of care to the registered practice population”.
Some examples of such roles are teaching or training roles, research, occupational medicine, minor surgery, dermatology, or cosmetic procedures. The RCGP gives two other factors which extend the definition of a GPwER:
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“A GP receiving referrals for assessment and treatment from outside their immediate practice”
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“A GP undertaking work that currently attracts an additional or separate medical indemnity fee (eg, as an emergency care ‘Basics’ or ambulance doctor)”
GPwER includes doctors previously working as GPs with Special Interest, or GPwSI/GPSI.
RCGP framework for guidance in GPwER competencies and accreditation
Before 2015, a GPwER was referred to as a GPwSI/GPSI. GPSIs however did not have a uniform guidance for accreditation, and there was a problem with finding an agreement in the rules and requirements for their accreditation and defining their competencies and roles within the NHS.
Consequently, in 2015, the RCGP introduced the term GPwER to replace GPSI, as well as a generalised ‘framework to support the national governance for GPwER’ which offers guidance on accreditation and competencies of GPs with Extended Roles.
This document is relevant for the following groups:
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GPs who are currently undertaking an extended role and wish to demonstrate continued competence
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GPs interested in undertaking an extended role
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Patients and their representatives, responsible officers, medical organisations, service commissioners, and provider/employer organisations
The RCGP framework for GPwERs is the basis for development of specific extended role frameworks which describe the knowledge, skills, and competencies that a GP needs to possess to work in a particular scope of extended practice.
The framework contains guidance on initial and ongoing demonstration of competence, and describes the accreditation process for GPwERs, and how it is delivered to RCGP standards. Although the NHS England contributed to the creation of the framework, the document is intended to be used in the other UK nations as well, but there may be some differences in the local arrangements.
Accreditation
The main difference in accreditation of GPwER compared to that of GPSI is that for GPwER, every physician undertaking this role is accredited as an individual, rather than just having the premises where they work accredited. This means that their accreditation is transferable if they decide to move their practice (within the UK).
The accreditation is a one-off process, and once a GPwER is accredited they do not need to renew it, however GPs are encouraged to participate in an annual specialty performance review in their extended role to ensure they keep their knowledge and skills up to date.
Although accreditation is thought of as best practice, not all specialties available to undertake as an extended role will require additional accreditation. RCGP is currently updating the accreditation guidance as they are no longer the accreditation providers.
The previously used specialty-specific frameworks are being reviewed and reworked to better tailor the guidance on accreditation and demonstrating competencies to each individual specialty and adapt the frameworks to the new generic GPwER framework.
A reviewed specialty-specific framework is currently being trialled on the Dermatology and Skin Surgery extended scope practice framework.
Regardless of whether GPwERs need accreditation for their extended roles, they should be able demonstrate competence, solid knowledge, and skills in all aspects of their work, and will be required to participate in activities that maintain and develop their performance.
If a GPwER does require accreditation for their extended role, since general practice is seen as their primary role, to be eligible for accreditation they must hold a Certificate of Completion of Training (CCT) in General Practice, or equivalent, they need to be practising in a primary care role and participate in an annual medical appraisal.
They must also have evidence of being currently registered and licensed and be in a good standing with the GMC.
Extended scope practitioner
Extended scope practitioner, or ESP, may sometimes be confused with the term GPwER. However, these are two distinct roles. They differ mainly in that an ESP does not have to be (and usually is not) a doctor while a GPwER must be a GP licensed to work in the GMC.
ESPs are physiotherapy clinical specialists with an extended scope of practice and additional training, usually in orthopaedics. The additional training qualifies them for ordering and interpreting imaging or blood tests, and to refer to other health care professionals. They often work alongside rheumatology and orthopaedics consultants.
Resources for GPwERs, and students, trainees, or GPs aspiring to be GPwERs
There are various GP courses available on the RCGP, such as the One Day Essentials, a series of one-day conferences with expert speakers on various topics, or more specific courses such as the Minor surgery courses for those interested in an extended role in minor surgery. This may help build knowledge and confidence in a particular area of interest.
Podcasts can also be useful to find out more about a specific area of general practice. The MDTea podcast, for example, discusses current important topics in geriatric medicine, and the BMJ talk medicine podcast episodes each discuss different topics, many of which may be relevant to an extended role specialty.
References
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General practice (GP). NHS Health Careers. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/general-practice-gp (accessed May 2021)
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General Practitioners with Extended Roles. Royal College of General Practitioners. Available from: https://www.rcgp.org.uk/training-exams/practice/general-practitioners-with-extended-roles.aspx (accessed May 2021)
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From GPwSIs to GPwERs: what’s the difference between the two? Gillian Kenny/GKA. Published May 2019. Available from: https://www.gilliankenny.com/blog/gpwsis-and-gpwers-nhs/ (accessed May 2021)
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RCGP framework to support the governance of General Practitioners with Extended Roles. Royal College of General Practitioners. Published 2018. Available from: https://www.rcgp.org.uk/-/media/Files/CIRC/GPwSI/RCGP-framework-to-support-the-governance-of-GPwERs-2018.ashx?la=en (accessed May 2021)
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Accreditation of GPs with extended roles (GPwERs) explained. Dr Cunliffe T. GPonline. Published May 2019. Available from: https://www.gponline.com/accreditation-gps-extended-roles-gpwers-explained/article/1583363 (accessed May 2021)
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Developing your career as a general practitioner. Wise J. BMJ Careers. Published July 2019. DOI: https://doi.org/10.1136/bmj.l4393 Accessed May 2021
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Specialist physiotherapy service. NHS trust North Bristol. Available from: https://www.nbt.nhs.uk/our-services/a-z-services/physiotherapy/specialist-physiotherapy-service (accessed May 2021)
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Live events. RCGP Learning: Courses and events. Available from: https://www.rcgp.org.uk/learning/courses-and-events.aspx (accessed May 2021)
