General practitioners with a special interest in respiratory medicine: national survey of UK primary care organisations

We sent a piloted semi-structured questionnaire to a random sample of 50% of English and Welsh primary care organisations (PCOs) (n = 161) during winter 2003. In addition to descriptive statistics, we used hierarchical cluster analysis to classify service priorities. Free-text responses to open-ended questions were analysed qualitatively by a multidisciplinary group to identify emerging themes.Of the 111 (69%) PCOs who responded, 7 (6%) already have, and a further 35 (32%) are planning, a respiratory GPwSI service. This proportion is considerably lower than in specialities linked to National Health Service clinical priorities. Local needs and pressure on hospital beds were the main described motives for developing a service. Stated service priorities were to relieve pressure on secondary care and to improve quality of care, including the strategic planning of respiratory services within PCOs.The relatively few respiratory GPwSIs currently in post reflects the lack of government prioritisation of respiratory care. However, respiratory GPwSI services are increasingly being considered as a local strategy for reducing pressure on secondary care respiratory services and raising standards of chronic disease management in primary care.The care of people with long-term disease is universally recognised as a major challenge, and national healthcare services around the world are reconfiguring to meet the demand [1,2]. Chronic respiratory disease is projected to rank as the fifth leading cause of morbidity by 2020 [3]. Increasingly, specialist roles are being devolved to family physicians, echoing recent global recognition of the contribution of primary care expertise to the management of common conditions such as respiratory disease [4]. Within the UK, the strong links between community-based practitioners and hospital specialists have long been valued and services increasingly draw on the resources of the two traditions to the mutual advantage of patients and clinicians [5].