Dr Burnt Out takes on the RCGP’s definition of a GP and posits an alternative
In 2023, the RCGP devised and published a definition of a GP. This may seem surprising considering that general practice is the oldest of all medical professions, with a history going back hundreds of years. But it seems that a definition of a GP had not previously been satisfactorily formulated. Perhaps, this was also somewhat forced onto the college – given that the terrain of primary care has changed significantly in recent years, with the advent of allied healthcare professionals, ARRS staff, clinical practitioners etc.
The RCGP definition is:
‘A GP is a doctor who is a consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care whilst managing the complexity, uncertainty and risk associated with the continuous care they provide. GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, taking into account their health care needs, stage of life and background. GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure all of their physical and mental health needs are met.’
Now, I agree with most of the definition, and I respect my GP colleagues who spent time working on this. But I do not agree with it all.
Firstly, I don’t like the term ‘consultant’ for GPs. This definition is not just for us; it is also for the general public, non-medic, patients that we see say in and day out. Any definition therefore must also make sense and chime with what our patients believe we are. People may disagree, but our patients do not think we are ‘consultants.’ The term has too much history and baggage as used for hospital-based specialists. It seems unwise that we adopt it for ourselves. I also think that the public are confused about what a GP is nowadays (let alone a PA or ACP.) So, we must make the definition as clear as possible as to what we are and what we do. ‘Consultant’ will undoubtedly confuse most of the public. To them we are not consultants (they work in hospitals) – we are GPs.
The second issue I have is the phrase: ‘GPs work in, connect with and lead multidisciplinary teams’. This means that a GP by definition must connect with and lead multidisciplinary teams. The idea that you must work in an MDT to be a GP seems like quite obvious nonsense to me.
Imagine: You are a trained GP on a remote island, perhaps off the coast of Scotland. There are no other medically trained people on the island. It is only you, several hundred human inhabitants and lots of sheep. There is no MDT – you are the GP and do everything: examine patients; do dressings; look at wounds; write letters about how a patient cannot look after the flock of sheep because they had some dodgy haggis the night before; dispense antibiotics; treat Orf etc.
Basically, like it was in the past for many single-handed GPs (my grandfather being one of them). Of course, you may sometimes need to get someone off the island to hospital and call for an air ambulance and need urgent help, but this is referring to secondary care – not working in a primary care MDT. According to this definition of a GP, this medic on the island is not a GP. But, in fact, this is ‘pure’ general practice where the GP sees and does everything, because there is no-one else around who has the skills and ability to do it.
You may think I’m nit-picking: why does this matter anyway?
Well, definitions are important. They literally define what we do and who we are as doctors – not only for ourselves, but for the Government, the public, and our medical colleagues. And the definition from our own professional body is fundamentally flawed. It does not recognise the strength, skills and experience that are unique to GPs.
In recent years there has been a misguided and absolute obsession with MDTs, paradoxically to the detriment of our own GP colleagues. For the last decade with multidisciplinary teams in primary care, it seems that the fundamental essence of what a GP is and does has been lost and silenced in the chaotic noisy and confusing environment that we now work in.
So, I suppose I need to offer up another definition as to what a GP is. Nowadays, in the current primary care climate I think it is probably necessary to absolutely specify that a GP is a medically qualified doctor, who has completed and passed the required training and exams.
So, for what it is worth here goes…
‘A GP is a doctor (who has finished and completed all the required general practitioner training) who uses their medical skills, training and knowledge to assess, diagnose, treat, aid, help and give advice to any individual person (or more), who comes to see them, or who they may encounter at their surgery, (or outside the surgery) whether this be for medical, social or any other reason where a doctor’s help is needed.’
That’s my attempt at a definition of a GP. It is almost certainly also very flawed – but at least it takes into account what differentiates us from other professions in primary care.
So, any other takers?
