General practice — the integrating discipline

Sir Denis Pereira Gray’s recent editorial in BJGP¹ is thoughtful and well researched. As a fan of the author’s work on continuity, I am disappointed to find myself commenting adversely on aspects of this recent paper.

Some patients may be lucky enough to belong to practices such as the author describes and indeed perhaps as offered in his own practice. However, frequently patients are now dependent on practices where not all the doctors are full time, where patients have great difficulty in getting a face-to-face appointment with a GP and that likely with a doctor they have never met. In such circumstances how can there be continuity of care and more importantly how can the GP possibly know the patient particularly, as the author says, in a 15-minute consultation? Sadly, the author is describing an almost romantic vision of general practice. It is now up to the patient who knows about how they feel, their illnesses and any changes in these and their circumstances to provide the continuity.

My next point concerns general practice as the integrating discipline. I read with interest the six special opportunities to integrate care in general practice. While the author emphasises the importance of getting to know the patient, their experiences, hopes and fears as an essential part of continuity, nowhere is it suggested that representatives of patients should be a central part of integrated care. Surely in 2023 that is essential for the present and the future. Such stated involvement of including patient representatives as the seventh special opportunity to integrate care in general practice would really strengthen the GP case as the integrated specialism as well as setting an example to all specialities.

Reference
1. Pereira Gray D. General Practice -the integrating discipline. Br J Gen Pract 2023; 73(734): 388-390. https://doi.org/10.3399/bjgp23X734697.