In the RCGP’s response to the independent Commission on Generalism, published last week, we set out a compelling case for why the role of the medical generalist must be more widely recognised across all medical specialties.
Our report defines medical generalism as an approach to the delivery of health care that routinely applies a broad and holistic perspective to the patient’s problems.
Key to this definition of generalism is the concept of interpretive medicine: a ‘biographical’ perspective, taken by professionals who are experts in dealing with people which, from the outset, is focused on individuals and how they deal with the world. Whether a practitioner is a true generalist or not depends on their training, their attitudes, their scope of practice, and frequently their work setting.
There is a difference between being a generalist and using generalist skills. A doctor who sees only patients with a specific set of clinical problems (for example, a family planning specialist) is acting like a generalist when they note nervousness in a female patient, and expand their remit to investigate undeclared risks, such as sexual abuse, domestic violence, sexually transmitted disease, or depression. However, they may have lost some skills in the diagnosis and management of other types of problems.
GPs (or ‘family medicine practitioners’ in other countries) are the quintessential generalists, because they routinely see people across all types of health and medical problems, at all stages of the lifecycle, and for any stage of a problem from health promotion to the management of severe ill health and frailty. We describe how medical generalists are ‘experts in whole-person medicine’ and how we provide care that is both focused on individual wellbeing and that delivers wider benefits, helping to ensure that the NHS remains one of the most cost-effective health systems in the world.
The independent Commission on Generalism – convened by the RCGP and the Health Foundation in March 2011 – rightly observed that GPs and generalists are so important in the NHS that ‘if they did not currently exist, they would have to be invented’. It advocated for better communication between specialists and generalists. It also called for more medical training to be generalist in its core approach, so that those taking up specialist appointments appreciate the skills of generalists, and can use them when required.
The recent recommendation by the Medical Programme Board for enhanced training for GP trainees will give a real opportunity to embed generalist competencies in those gaining MRCGP, and to enhance the status of primary care medical generalists. Now we challenge other medical specialities to consider their own need to train and retain generalists within their own disciplinary context.
Of course, the relationship between generalist and secondary care is not the only aspect of generalism covered in our far-reaching report and we have identified other important areas where generalist skills are important – including out-of-hours care policy and nursing home care.
We call for general practitioners to be given more support to protect and enhance their vital role, including longer training; more time with patients; better access to diagnostics, and better communication with specialists
In conclusion, primary care teams in the UK provide generalist services free at the point of use to their patients who can develop relationships with staff over time and get help with health care regardless of their age, need, or problems.
This is true generalism, which has a set of core skills, principles, and an appropriate ethos of generalist medical care. It is about kinder, safer, more efficient care, and it is about helping people.
GPs are experts in whole-person medicine; but other specialities and settings also need to provide generalists to ensure that we together can guide our patients safely through the complexity of modern medical care.
Dr Amanda Howe is a GP in Norwich, professor of primary care at the University of East Anglia and honorary secretary at the RCGP.