The RCGP Curriculum: Being a General Practitioner

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.¹

This definition applies to doctors within general practice who have obtained GP status on the specialist register.

GPs and their patients

Through confidential trusted partnerships with their patients (characterised by empathy and mutual trust, without bias or judgement), GPs provide evidence-informed personalised care in the community in an accessible way. Whether remotely or in person, they lead, support and embrace innovation in medicine and technology, while working as an advocate for their patients and the population, to optimise the care they provide. 

Outside the practice

As consultants in general practice, GPs can contribute to healthcare in many other ways beyond the GP surgery. They may work in local, regional and national medical leadership and commissioning roles, undertake research and provide education, work in extended clinical roles or provide 24-hour, 365-day care within organisations that cover patient care outside standard GP opening hours. 

To ensure the definition is future-proofed it is suggested that it be reviewed on a five-year cycle.

The definition should be used to represent all qualified GPs, irrespective of whether they work in the NHS or in other parts of the health and care system. The definition does not represent any other clinician or doctor who may work in primary care.

The scope practice² of a GP in the NHS is defined by Standard General Medical Services Contract. It includes:

• the first-contact assessment and management of patients who are ill, or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable
• out-of-hours services
• management of long-term conditions disease in the manner determined by local needs, in discussion with patients
• care of people in nursing homes
• the general management of patients who are terminally ill
• a range of nationally or locally commissioned services that are normally expected of all practices: cervical cytology, child health surveillance, maternity services (not intrapartum care), contraceptive services
• an extended range of services delivered by primary care organisations, such as childhood immunisations and minor surgery.

Clinical and non-clinical areas where care by a GP plays an essential role include:

• clinical care – covering a wide range of long-term conditions, including asthma, atrial fibrillation, cancer, chronic kidney disease, chronic obstructive pulmonary disease, coronary heart disease, dementia, depression, diabetes, epilepsy, heart failure, hypertension, hypothyroidism, learning disabilities, mental health, obesity, palliative care, smoking, stroke and transient ischaemic attack
• organisational aspects of running a practice – including records and information governance, patient communication, education and training, practice management and medicines management
• patient experience and feedback.

As a generalist, a competent GP requires a high level of understanding across the full range of medical and surgical specialties, with additional skills to provide appropriate care in a safe and cost-effective way. Services have expanded to include taking responsibility for a number of services historically provided in non-primary care environments.

Research on continuity of care³ – that is, the extent to which a patient experiences an ongoing relationship with a clinical team or member of a clinical team – has demonstrated that continuity is associated with lower mortality, fewer acute admissions and lower use of out-of-hours services, alongside better quality of care, including better prescribing, better adherence to medical advice and medication, and cost-effectiveness.

It can consist of relational continuity (seeing the same people or team or management continuity), management and co-ordination of care and informational continuity (continuity of patient records and information).

Continuity of care is a critical element of general practice, particularly continuity of the personal relationship between patients and their GP.

Proposals for future reform of GP training include the development of an adaptable future primary care workforce, a place-based approach to educational governance, quality and faculty development, and alignment and integration with local models of care that provide optimal learning opportunities aligned to the individual needs of the GP registrar.

These ambitions should be supported by an increased emphasis on the core capabilities of being a GP, enhanced skills in generalism and digital technologies, leadership development and meaningful quality improvement activity and skills development. Specific focus is given to equity in training and social accountability, better wellbeing and mental healthcare in general practice and the community, improved earlier diagnosis and detection of illnesses such as cancer, and greater awareness of population and planetary health in practice.

References

1. Royal College of General Practitioners. Definition of a GP. Consensus statement September 2023. www.rcgp.org.uk/about
2. NHS England. Standard General Medical Services Contract 2024/25. NHSE, 2024. www.england.nhs.uk/publication/standard-general-medical-services-contract-24-25/
3. Royal College of General Practitioners. Continuity of care work at RCGP. RCGP, 2021. www.rcgp.org.uk/blog/continuity-of-care-work-at-rcgp