Introduction

Purpose statement

Since its introduction in 2007, the RCGP curriculum has described the attitudes, skills and expertise required to become a competent GP in the UK NHS. It sets out the educational framework that forms the basis of the discipline of general practice and builds a foundation for career-long development.

The RCGP has published a comprehensive analysis of the challenges faced by general practice and primary care,based on evidence from an extensive body of national and international research. This identified specific challenges in addressing the increasing demand for healthcare against diminishing resources and rising real-term costs. These include:

  • an increase in the number of patients with long-term conditions and multimorbidity
  • ageing populations
  • the need to deliver more integrated, multidisciplinary care
  • the challenge of addressing health inequalities and the greater need for disease prevention
  • the importance of engaging patients in their own care
  • working within financial and workforce constraints.

An analysis of the role of a GP2 identified the need for more emphasis on the skills and capabilities of GPs outside the consulting room, relating to leadership, professionalism and engagement in commissioning activities.

Increasingly, GPs are required to consider how their work impacts at a community level, and how this aligns with the health system as a whole. Population health problems such as obesity, child health, mental health and comorbidity are highly complex and are increasing in number, putting a greater burden on health services. There is a continuing challenge of non-communicable diseases such as cardiovascular disease, cancer and liver disease, alongside the new lifestyle-related challenges of obesity, alcohol dependence and type 2 diabetes.

Continuity of care is highly valued by patients and is a key process through which therapeutic relationships are built and maintained over time. It is a prerequisite for effective generalist care.

The growth in the prevalence of long-term conditions and multimorbidity means that the success of general practice in integrating care will play an increasingly important role in shaping the future trajectory of healthcare expenditure.

The RCGP's vision for General Practice in 2030 is set out in 'Fit for the Future – A vision for General Practice'.It describes the contribution of general practice as the bedrock of the NHS.

This vision aligns with strategic workforce plans across the four nations by improving retention in the profession and increasing the attractiveness of General Practice as the first-choice career for medical graduates. 

Patients experiences, needs, and preferences will be at the heart of the vision for general practice. Patients expressed their wish to be treated as individuals and equal partners with healthcare teams and receive joined up care from professionals. They would like the ability to manage their own health proactively supported by flexibility in how and when they see their GP with the appropriate and dependable use of technology.

A revitalised profession will allow GPs to achieve greater job satisfaction through a manageable workload. They will continue to provide relationship-based whole person-centred care with time to care for the complex needs of patients through a wider variety of types of consultation. The expert generalist will be increasingly highly valued with extended roles and areas of expertise.

By working in expanded teams, care will be delivered by multidisciplinary professionals offering a wide range of community services. The creation of new roles in primary care will complement the skills of the GP who will provide leadership, advice, training and mentorship. 

GPs will collaborate with neighbouring practices and local populations to provide care across the traditional boundaries between hospitals, primary care and social care. Wellbeing services will help to build strong and resilient communities.

We see a general practice in the future that is forward thinking whilst maintaining what we know patients value: continuity of care, a truly holistic approach to medicine that treats the whole person, not just their condition, and that is rooted in the community.

Rationale

Defining the scope of services provided by general practice is challenging because of its generalist and comprehensive nature, but it is outlined in the NHS General
Medical Services contract.

Broadly, the scope of a GP 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
  • the general management of patients who are terminally ill 
  • management of chronic disease in the manner determined by local needs, in discussion with patients
  • 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 more specialised or extended services delivered by primary care organisations, which can include childhood vaccinations and immunisations; minor surgery; clinical priorities, for example heart failure, osteoporosis, alcohol, learning disabilities, avoiding unplanned admissions and elderly frailty assessment; anticoagulant monitoring and near-patient testing; intrauterine contraception and sexual health; drug and alcohol misuse; care of homeless people; immediate/first response care; intra-partum care; minor primary services such as phlebotomy; electrocardiography; spirometry; and care of people in nursing homes.

Attention to measurable outcomes has helped to focus on both clinical and non-clinical areas where care by the GP plays an essential role:

  • 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 secondary care.


Next: How the curriculum is structured >

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