Area of capability: Caring for the whole person, the wider community and the environment

This capability considers physical, psychological, socio-economic and cultural dimensions of health. As a generalist medical practitioner, it is imperative to understand that each patient is an individual for whom you should non-judgementally and compassionately acknowledge their thoughts, feelings, values and behaviours in the following settings: health improvement, self-management during illness and recovery, and shared care planning with patients and their carers.

Medicine, like any cultural practice, is based on a set of shared beliefs and values and is an intrinsic part of the wider culture. According to Kemper, it involves “caring for the whole person in the context of the person’s values, their family beliefs, their family system, and their culture in the larger community, and considering a range of therapies based on the evidence of their benefits and cost”.

A key aspect of holistic care is safeguarding the health and welfare of patients, families and local populations. As a GP, you will need to be alert and ready to respond to the full range of safeguarding concerns and the diverse contexts in which they present, taking appropriate and effective action when required, such as training on the Prevent duty to tackle radicalisation.

Holistic care can be interpreted only in relation to an individual’s perception of holism. This means that even if you offer the same health advice, treatment or interventions, these will have different meanings for different people. This view acknowledges objective scientific explanations of physiology, but also admits that people have inner experiences that are subjective, mystical and, for some, religious, which may also affect their health and wellbeing.

Demonstrating the holistic mindset of a generalist medical practitioner

Learning outcomes:

• Appreciate that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. 
• Recognise that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition, and your role to facilitate this.
• Enquire routinely into the psychosocial, cultural, and socio-economic aspects of the patient’s problem in addition to physical aspects, integrating this information to form a non-judgemental holistic view.
• Interpret each patient’s personal story in their unique context with compassion, considering the effects of additional factors that are known to influence an individual’s health needs, including educational, occupational, environmental, cultural, spiritual and other existential factors.
• Develop the ability to switch from diagnostic and curative approaches to supportive and palliative approaches, as appropriate for the patient’s needs.
• Integrate a diverse range of evidence-based approaches into treatment plans, according to patient preferences and circumstances, incorporating both conventional and complementary approaches where appropriate.

Supporting people through their experiences of health, illness and recovery with a personalised approach

Learning outcomes:

• Recognise that every individual has a unique set of values and experiences of health and illness that may affect their use of the healthcare system, and incorporate this perspective into your decisions without judgement.
• Acknowledge the impact of the problem on the patient, such as how it affects their daily functioning, education, occupation and relationships.
• Recognise the impact of the problem on the patient’s family and carers, social context and community.
• Anticipate the health issues that commonly arise during the expected transitions of life (including childhood development, adolescence, adulthood, ageing and dying).
• Understand and identify the barriers of patients to attend education or work, and support and promote strategies for reintegration. 
• Engage with agencies and carers to enhance patient autonomy and support their self-management during illness and recovery, in addition to promoting health improvement.
• Facilitate individually tailored health literacy and provide evidence-informed support for optimising the patient’s lifestyle and wellbeing.
• Demonstrate the skills and assertiveness to challenge unhelpful health beliefs or behaviours while maintaining a continuing and productive relationship.
• Identify those individuals, including young and older people, who play an important role in caring role for others, involve them in management decisions and offer them additional support.

Safeguarding individuals, families and local populations

General practice is one of the key multi-agency safeguarding partners that work together to prevent and stop abuse and neglect. GPs play a crucial role in safeguarding their patients, especially the most vulnerable. The RCGP safeguarding standards for general practice (2024) are built on five different areas of safeguarding knowledge and capabilities that can be mapped to the RCGP curriculum.

Learning outcomes:

• Recognise how safeguarding concerns may present in general practice at differing scales, from individuals (such as cases of domestic violence or child abuse) to families, identified populations (for example local schools or care homes) and communities (such as those affected by human trafficking or child sexual exploitation).
• Anticipate the safeguarding issues that commonly arise during different stages of life and the settings or contexts that may increase an individual’s vulnerability or risk of harm.
• Respond safely, promptly and effectively to the full range of safeguarding needs and risks that you are likely to encounter in practice.
• Use appropriate systems for identifying and sharing information, recording and raising concerns, obtaining advice and taking action.
• Report concerns to appropriate professionals and authorities and actively participate in discussions, plans and actions to investigate and mitigate identified risks.
• Comply with your professional and legal responsibilities in relation to safeguarding, including the reporting of harmful and illegal activities and procedures (such as female genital mutilation, radicalisation and modern slavery).
• Acknowledge and manage the diverse impacts of safeguarding issues on the individuals affected, including their functioning, education, health, occupation and relationships.
• Recognise and respond appropriately to the wider impacts of safeguarding issues on the family, carers and the local community, as well as on the professionals involved.
• Demonstrate compliance with statutory requirements for adult and child safeguarding, as applicable to your role and working environment.

Progression point descriptors – Holistic practice, health promotion and safeguarding

The health of individuals is deeply interconnected with the health of populations and the planet. Every individual primary care encounter is influenced by the wider social, economic, political and geographical landscape in which it is embedded. Viewing the clinical encounter through these wider lenses will allow you to acquire, reflect on and reinforce the skills and knowledge needed to adopt an evidence-informed, environmentally sustainable practice.

Your work as a family doctor is determined by the make-up of the community in which your practice is based. Therefore, you must take steps to understand the demographics, advantages and limitations of the community in which you work. You also have an ethical and moral duty to influence health policy in the community and to work with patients and carers to ensure their needs are met.¹

It is important to understand the health service and your role within it. The tension between the needs of an individual patient and the needs of the wider community is becoming more pronounced and it is necessary to work within this. For example, healthcare systems are being rationed in all societies and doctors are inevitably involved in the rationing decisions. 

Environmental change and other factors such as globalisation are altering the epidemiology of diseases seen in the UK. You must therefore be aware of global health issues and display a responsibility towards global sustainability, protecting the planet and its inhabitants, resources and ecosystems, both as a citizen and in your professional role. 

Improving health at the level of the individual, community or wider environment is underpinned by capabilities that are already core to general practice, such as good communication skills, data gathering and managing complexity.

Understanding the health service and your role within it

Learning outcomes:

• Describe the current structure of your local healthcare system, including the various roles, responsibilities and organisations within it, applying this understanding to improve the quality, sustainability and safety of the care you provide.
• Identify local services and how they can be accessed; use this understanding to inform your referral practices.
• Demonstrate an understanding of the financial restrictions within which healthcare operates and identify how the limitations of local healthcare resources might impact on patient care.
• Optimise your use of limited resources (for example, through cost-effective, environmentally friendly prescribing).
• Within available resources, demonstrate approaches that balance the needs of individual patients with the health needs of the local community.
• Recognise how the roles and influence of the GP span the healthcare system, including (but not limited to):
  • first-contact clinician
  • personal doctor and family practitioner
  • coordinator of complex and long-term care, balancing acute and chronic care
  • patient advocate
  • service navigator and gatekeeper
  • clinical leader, commissioner and quality improver
  • employer, employee, contractor, manager and business leader
  • educator, supervisor, appraiser, researcher and mentor.
• Identify the opportunities that this expanded role provides for reducing inequalities and improving local, national and global healthcare.

Building relationships with the communities in which you work

Learning outcomes:

• Recognise that groups or communities of patients may share and value certain characteristics and have common health needs, and use this understanding to enhance your care while continuing to acknowledge that people are individuals.
• Analyse and identify the health characteristics of the populations with which you work, including the cultural, occupational, epidemiological, environmental, economic and social factors and the relevant characteristics of ‘at-risk’ groups.
• Explore the interactions of these characteristics and impacts on the health needs and expectations of your community and its use of the services you provide.
• Contribute your insights to the development of new services in your organisation or locality.
• Acknowledge your professional duty to help tackle health inequalities and resource issues.
• Manage the conflicts of interest created by the differing needs of individuals, the requirements of the wider population and the resources available in the community, and adopt approaches to manage these tensions in your work.
• Recognise that individuals, families and communities form a continuum, with each affecting the other, requiring a system-wide understanding of health and social care.

Promoting population and planetary health

Learning outcomes:

• Participate in protecting and improving the health of populations.
• Understand and apply the principles of health promotion and disease prevention. 
• Apply your understanding of the wider determinants of health to address health inequalities and inequities.
• Use resources and services judiciously, maximising their effectiveness while minimising harm to people and the planet.
• Consider the environmental, social and economic sustainability of health services through measures such as
  • identifying the carbon footprint of different elements of primary care (for example, prescribing, travel, heating, paper and plastics)
  • appropriate changes to prescribing (for example, use of dry powder inhalers, deprescribing) and patient pathways.
• Assess, monitor, and address the needs of local population groups.
• Understand, assess and communicate risk to individuals and local populations. Consider risks beyond the individual, such as to the wider community and planet.
• Advocate for measures to improve the health of populations and the planet as well as individuals.
• Be aware of planetary health theoretical models (for example, systems thinking, characteristics of sustainable health systems and the Sustainability in Quality Improvement (SusQI) approach)^2.
• Recognise the value of assessing outcomes for patients and populations in relation to their environmental, social and financial impacts.

Progression point descriptors – Community health and environmental sustainability

References

1. Kemper KJ. Holistic pediatrics = good medicine. Pediatrics 2000; 105:214–18 https://doi.org/10.1542/peds.105.S2.214
2. https://www.susqi.org/the-susqi-education-project