What is the role of the GP in modern general practice?

Problem

With too few GPs policy has focused on increasing use of a multi-professional workforce: in comparison to ARRS roles much less attention has been given to the role of the GP or to identifying how to make best use of the GPs that are available. The aim of this paper is to provoke thoughtful debate on the role of the GP, identify key issues, and support policy development.

Approach

We reviewed relevant peer-reviewed and policy literature, using a discursive approach to explore the role of the GP from a variety of perspectives including practicing GPs, wider members of the general practice team (advanced nurse practitioners, clinical pharmacists, paramedics), patients, and policy leaders.

Findings

A decade of sustained policy reform across multiple areas (access, workforce, digital, organisational scale) has shifted and significantly reshaped the role of the GP. The work GPs do in making sense of ambiguous symptoms (undifferentiated illness), demedicalising where appropriate, and holding clinical risk in the community is highly skilled - but it’s importance, including to safety and efficiency of care, is often poorly understood and not always recognised in wider policy conversations. Our analysis highlights the need for stronger alignment between the role of the GP and the purpose and function of general practice. And to understanding the contribution GPs make to high quality care and productivity in the NHS both in terms of what GPs do and, just as importantly, what they do not do.

Consequences

Greater clarity on the role of the GP, and a reinvigorated emphasis on medical generalism, are needed as part of the bedrock for building a strong vision for the future of primary care. Policy must strike a balance between use of GP time to support and supervise multidisciplinary teams, and making the most of what it is that general practitioners are highly skilled and experienced at and do best. Current policy approaches are leading towards a more transactional model of care and risk losing sight of – potentially even ‘designing-out’ – the highly-skilled work GPs do in managing clinical risk and uncertainty: work that supports better health outcomes for individuals and adds value to the wider health system. The challenge for GP practices is finding ways to hold on to these benefits in the context of new ways of working. Primary care research is needed to understand how in the context of multi-professional team working clinical assessment of ambiguous symptoms can be done safely, and efficiently - especially if patients are moving between different members of a clinical team. The implications of role substitution, vicarious risk, and the taskification of general practice should also be addressed in future research and policy development.