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The development of specialist clinical interests by general practitioners (GPs) is currently receiving considerable attention in the United Kingdom. Although GPs have long been able to pursue such interests, it is only in recent years that they have taken on within primary care what were previously secondary care tasks, provided such services for patients outside their own practices, and received payment for them. The expansion of such services has been highlighted as a target in the NHS plan for England. Managerial and professional guidance is becoming available that seeks to clarify the role and nature of specialisation within general practice, to learn from the experiences of individuals who have embarked on specialist practice, and suggests procedures for future developments. Drawing on a range of sources, this paper builds on that burgeoning knowledge by setting the development of GPs with special interests in a broader policy context, highlighting the implications for the way that healthcare services are organised and delivered, and discussing their actual and potential impact of professional roles and practice.