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Valuing General Practice

The key attributes of a general practitioner that we must value, support and develop include:

 Complex clinical skills

A general practitioner is presented with the full range of symptoms, signs and histories in the physical, psychological and social domains. Dealing with these needs high level knowledge, the ability to tolerate uncertainty, the skill to create a safe, effective but not unnecessarily complex management plan, and high-level communication skills.

While a protocol can offer guidance in the management of uncomplicated cases, most patients are not uncomplicated and many have extensive co-morbidity: angina, hypertension and depression, for example. The capacity to deploy these skills in a short, ten minute, consultation requires a breadth of biomedical and psychosocial knowledge to be matched to the enormous variety of patient presentations. Many come with “metaphorical” symptoms that need to be unwrapped to reveal the underlying problem. For others, a misinterpretation of the significance of their symptoms can lead to either inappropriate long-term adoption of the sick role or delayed reaction to the early signs of important illness.

The complexity of this role, the gatekeeper between perceived illness and disease, must not be underestimated. It is a role for which nurses are not trained. General practitioners are recruited from the most able school leavers and then intensively trained for nine years. The complexity of the general practitioners’ role demands these attributes and is supported by the general practitioner’s perceived therapeutic authority.

Flexibility

Flexibility is a hallmark of the personal care delivered by a general practitioner. GPs reformulate their care to meet the needs of individual patients as they evolve, developing roles to suit the needs of patients. This flexibility is the fundamental key to the high quality and high reputation of most general practice. It offers personally tailored care including the right access to the right parts of the health service when appropriate. Formulaic, protocol-driven care can undermine patient autonomy within the consultation.

Demand management

Demand management results from general practitioners empowering patients to take responsibility for their own care when appropriate; from identifying the right routes through the primary and secondary care services; and from taking increasing responsibility for complex patient care in general practice.

Continuity of care

Continuity of care is highly prized by patients. Seeing a doctor who knows the patient and remembers key events in the life of that patient and the family, who will be there subsequently when required and who takes a longer term view of care and its outcomes is an important feature of primary care. Continuity has been shown to reduce use of secondary care services and to improve patient satisfaction. Of course, GPs take holidays, retire and move on; not all patients see “their” GP. But continuity is supported by four crucial features:

1. The life-time clinical record
   is retained in general practice. The general practitioner is its guardian although we support the concept of a patient held and patient involved record. This record is the key to efficient and safe health care delivery.

2. A population perspective
    is a key aspect of modern general practice, with health needs assessment, health inequalities and commissioning being addressed.

3. Advocacy
   on behalf of individual patients, groups of patients and whole communities requires a variety of skills, an overview of the health and social system, the ability to detect and address inequalities and an involvement in commissioning. Good advocacy is based on a shared understanding, which in turn is greatly facilitated by continuity.

4. Team working
   is now a key feature of general practice with professional isolation being less common. However the general practitioner fulfils a key role within the team and is a central player in the team success of primary care. In particular the general practitioner takes responsibility. The GP continues to take responsibility long after social workers, physiotherapists and practice nurses have finished work.

 Source: RCGP

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