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08 • Careers


SKIN DOCTORS


With dermatological referrals increasing – what better time to consider becoming a GP with a special interest in dermatology?


interest (GPwSI) could have a significant impact by reducing waiting lists and delivering modern, patient-centred care. A GPwSI is defined as a doctor who:


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 takes referrals that may otherwise have gone directly to a secondary care consultant


 is first and foremost a generalist  is able to act without direct supervision


 has a level of skill or competence that exceeds the core competences of the individual’s normal professional role and


 is accredited to deliver specialist clinical services directly to patients.


Dermatology GPwSIs have various training options: dermatology (Group 1); dermatology and skin surgery (Group 2); and dermatology, skin surgery and community skin cancer (Group 3).


Training A GPwSI competency framework for dermatology was developed in 2007 and updated in 2011. The revised GPwSI guidance also provides detailed information to ensure that accreditors know the kind of evidence and competences that may be expected to be seen and tested during the accreditation process set out in Implementing care closer to home: Convenient quality care for patients, Part 3: The accreditation of GPs and Pharmacists with Special Interests. The competences required to deliver a GPwSI service are seen as a


development of generalist skills as outlined by the RCGP and BAD in Dermatology for General Practice Trainees. There follows on from this a curriculum for GPwSI training. This is considered to be the minimum core curriculum for any generalist wishing to offer more specialist dermatology diagnosis and management services. Practitioners are expected to show they have completed


recognised training, which may include acknowledgement of prior learning and experience. This can be acquired in different ways:


 Relevant, current or recent experience (within the last five years) in a specialist dermatology department


 Successful completion of an appropriate postgraduate qualification in dermatology and/or dermatological surgery (e.g. diploma) – this


HE treatment of skin disorders is estimated to take up almost a fifth of GPs’ consultation time while increasing demand for outpatient appointments has seen waiting lists rise in recent years.


The specialty has been highlighted by the Department of Health (DoH) as an area where GPs with a special


is recommended as a good way of obtaining and demonstrating structured learning


 Self-directed learning via the internet with evidence of the completion of individual tasks


 Attendance at recognised meetings/lectures/tutorials on specific relevant dermatological topics.


Practical training is tailored to the service requirements of the GPwSI, who must attend sufficient clinics to obtain the necessary training and experience to demonstrate the competences required for accreditation. A number of different teaching and learning methods include:


 Attachment to a dermatology unit under the supervision of a consultant dermatologist (or plastic surgeon for surgical skills)


 A periodic case note review by the supervising consultant


 Attendance at a structured course of lectures/tutorials designed to cover basic dermatology


 A combination of clinical assessments and direct observation of practical skills.


Postgraduate diploma courses in clinical dermatology are offered by universities including Cardiff University and the University of London (Queen Mary College) with final examinations at the end of the course. However, possession of the diploma does not endorse the practitioner to work as a specialist in dermatology as they would still need to meet the requirements set out in DoH guidelines. GPs interested in becoming GPwSIs are encouraged to approach their health board/PCT/GP consortium to make proposals or to get advice on services required locally. Trainees with special interests may consider doing a diploma or other training during their vocational training scheme, although this is not essential.


In practice The proposed dermatology service is likely to be accredited first, and the dermatology GPwSI will then be accredited in the context of the service to be provided and the competences required to provide it. Accredited GPwSIs can take referrals from local GPs to carry out clinical services beyond the scope of traditional general practice. Most will continue to be practising GPs, and will only perform GPwSI duties for a limited number of time slots (or sessions) per week. Accredited GPwSIs are normally appointed and paid for by the health board/PCT/GP consortium based on local need and must also have their service accredited. Trusts may also employ GPwSIs to deliver


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