Open Access Open Badges Research article

A study of role expansion: a new GP role in cardiology care

Lorraine Pollard1, Stephen Rogers2*, Jonathan Shribman3, David Sprigings4 and Paul Sinfield1

Author Affiliations

1 Department of Health Sciences, University of Leicester, 22 -28 Princess Road West, Leicester LE1 6TP, UK

2 Public Health, Northamptonshire County Council, Guildhall Road, Northampton NN1 1DN, UK

3 NHS Nene Clinical Commissioning Group, Francis Crick House, Summerhouse Road, Moulton Park, Northampton NN3 6BF, UK

4 UK Cardiology, Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, UK

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BMC Health Services Research 2014, 14:205  doi:10.1186/1472-6963-14-205

Published: 6 May 2014



The National Health Service is reconfiguring health care services in order to meet the increasing challenge of providing care for people with long-term conditions and to reduce the demand on specialised outpatient hospital services by enhancing primary care. A review of cardiology referrals to specialised care and the literature on referral management inspired the development of a new GP role in Cardiology. This new extended role was developed to enable GPs to diagnose and manage patients with mild to moderate heart failure or atrial fibrillation and to use a range of diagnostics effectively in primary care. This entailed GPs participating in a four-session short course with on-going clinical supervision. The new role was piloted in a small number of GP practices in one county in England for four months. This study explores the impact of piloting the Extended Cardiology role on the GP’s role, patients’ experience, service delivery and quality.


A mixed methods approach was employed including semi-structured interviews with GPs, a patient experience survey, a quality review of case notes, and analysis on activity and referral data.


The participating GPs perceived the extended GP role as a professional development opportunity that had the potential to reduce healthcare utilisation and costs, through a reduction in referrals, whilst meeting the patient’s wishes for the provision of care closer to home. Patient experience of the new GP service was positive. The standard of clinical practice was judged acceptable. There was a fall in referrals during the study period.


This new role in cardiology was broadly welcomed as a model of care by the participating GPs and by patients, because of the potential to improve the quality of care for patients in primary care and reduce costs. As this was a pilot study further development and continuing evaluation of the model is recommended.

GP; Primary care; Cardiology; Referrals; Extended; Role; Patients; Management (9)