The vital role of the “medical generalist” – or “expert in whole-person medicine” – has to be more widely recognised and enhanced if the NHS is to meet the challenges facing it, a new report emphasises.
The importance and influence of the role of medical generalists needs to be given fresh consideration within a much wider context than general practice and primary care, according to the study, which is the Royal College of General Practitioners (RCGP)’s formal response to the findings of the Independent Commission on Generalism, which reported last October.
The Commission’s report had found that, overall, generalists and GPs are so important in the NHS that “if they did not currently exist, they would have to be invented,” the Royal College points out.
However, the Commission also concluded that, while medical generalism is the cornerstone of the UK healthcare system through general practice, it remains poorly-recognised, but it has a strong and growing part to play in the way that healthcare needs to change to respond to an ageing population with multiple chronic conditions.
Medical generalists provide care that is both focused on individual wellbeing and delivers wider benefits, helping to ensure that the NHS remains one of the most cost-effective health systems in the world, says the RCGP’s response to the Commission study.
GPs need to be given more support to protect and enhance their vital role – including longer training, and they also need more time with patients, better access to diagnostics and better communication with specialists, it says.
The RCGP response identifies 10 priority areas which aim to review the disciplines of GPs and other medical generalists from different perspectives, and ensure they are equipped to meet the changing needs of their patients. These are: – effective use of patient feedback; – policy on out-of-hours care; – development of generalist models of care for complex and chronic conditions in the community; – extended training for GPs; – enhanced training in paediatric care, learning disabilities, mental health, palliative and end-of-life care; – GP-led commissioning; – further research into multiple morbidities and early, accurate diagnosis in primary care; – use of IT, data-sharing and inter-agency e-communications; and – nursing home care.
“Generalists are professionals who are committed to the patient as a person,” said Professor Amanda Howe, RCGP honorary secretary. “They retain responsibility for patients over time, deal with many issues and help patients to make judgements that are safe for them and the system.”
“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 a generalist and using generalist skills,” she pointed out.
“The GP remains the front door and the community interface of the NHS, and principles of practice are still based on two key concepts – holistic and patient-centred care. Our report shows that GPs are very positive about seeing the basis of our discipline from a new perspective and are keen to have the value and skills of medical generalists more strongly supported across the modern NHS,” said Prof Howe, who is leading this work.
Adrian Sieff, assistant director at the Health Foundation – which, with the RCGP, established the Independent Commission on Generalism – welcomed GPs’ commitment to the patient as a whole person. “Seeing the person in the patient and understanding the needs, wishes and priorities of each individual is vital to improving the quality of healthcare,” he said.
Following publication of the RCGP’s response, Prof Howe said: “we now invite others across the clinical and political spectrum to engage with the next steps which will make medical generalism a real force for effective and efficient personalised healthcare in the 21st century.”
