As Iona Heath handed over the Presidency of the Royal College of General Practitioners (RCGP) in 2012, she gave an interview in which she warned of the risks of focusing on practical expediency (contracts) at the neglect of protecting the essence of effective professional practice (continuity of care).1 Twelve years on, we find ourselves back in the same position. The details differ slightly, but at the core is a debate about the future of the profession. It is time, once again, to stand up for the discipline of general practice.
The recent publication of the new RCGP definition of general practice is just one part of the College’s work to do just that.2 It is the product of months of work led by Gail Allsop and Michael Mullholland on behalf of the College. The work recognised the need for an updated, succinct account of the unique contribution of GPs in a rapidly changing NHS and primary care context. Through a series of focus groups, surveys, and discussions, the working group systemically sought and distilled input from stakeholders across the GP community.
As thoughts and ideas were presented to the working group, each was critically examined against a single standard — did it clearly delineate how the GP role is distinct and unique within today’s multidisciplinary complex primary healthcare setting? Some people challenged the suggestion of using a single reference point, arguing that the GP role is defined by the sum of its many parts.3 But the working group recognised that a rich and diverse multidisciplinary team now contributes to many of the individual elements. The goal in establishing a new definition was to recognise the distinct contribution of the GP in that context. These complex discussions were distilled into the opening statements of the new definition.
The statement clearly delineates the distinct contribution of GPs within a wider team as a consultant in community-based whole-person medicine. It defines the profession by the nature of their distinct medical expertise; not by the work they deliver, contract they hold, or extended skills that they use to enable and optimise practice in the community context. As such it provides three vital functions for the discipline: a benchmark against which to critically compare proposed new roles for GPs; a springboard for change in the design and implementation of primary medical care; and a celebration of stature for our discipline.
A benchmark for emerging new roles
Primary care faces urgent challenges. Decisions are being made now about general practice that will potentially shape the role of GPs for years to come. But, too often, these decisions are being made without adequate understanding of the distinct contribution that the discipline of general practice medicine makes to modern health care.4 As a result, we risk losing this expertise at the time when it is most needed.
The new definition therefore offers a benchmark against which all suggested changes must be held up for scrutiny. Any proposals to introduce new clinical roles, digital technology, or changes in medical training must demonstrate how the changes ideally enhance, and certainly don’t undermine, the practice of the distinct whole-person medical care recognised by the new definition.
A springboard for change
General practice is the distinct clinical discipline of community-based, whole-person (advanced generalist) medicine. It is delivered as part of a complex organisational/systems intervention that is general practice. Organisational general practice is therefore made up of lots of component parts; and, by necessity, there is variability in which elements are needed in different contexts. For example, rural isolated communities may have different access needs for interventional services than those in urban settings.
Scientific definitions of complex interventions5 require this combination of core, constant components that make an intervention distinct, together with variable elements that give the intervention the flexibility needed to manage complexity. Organisational general practice can therefore be understood as a complex intervention, with both the core (community-based, advanced generalist medicine) and variable components described within the new definition (Table 1).
Table 1. The complex intervention that is general practice — an advanced generalist perspective
The new definition therefore provides the framework we need not only to recognise and benchmark proposed changes, but also to enable critical evaluation of their impact using complex intervention research approaches. The new definition provides a framework against which existing and proposed new models of general practice provision can be critically examined, challenged, and extended.
A celebration of visible stature
Finally, the definition provides a visible status for GPs within the extended medical community in two ways.
First, it is nearly 10 years since the Wass report challenged the ‘just a GP’6 label that was seen to act as a barrier to students recognising the value and opportunities of a general practice career. But, as yet, we haven’t seen a clear and consistent alternative emerge. ‘I am a consultant in community-based whole-person medicine — general practice’ fills that gap.
Second, the extended definition, linked to our description here of a complex intervention model, provides a framework by which GPs can recognise and visibly celebrate their diverse, but always tailored, contributions. For example, future applicants for College Fellowship may use this model to present a focused account of the extended contributions they make to both support their communities and further the discipline.
Next steps
In a rapidly changing NHS context, we have drawn a line in the sand for general practice.
We underline both the unique, steadfast contribution of the discipline of general practice, and the flexibility of its organisational model that allows it not only to adapt and innovate but also embed and sustain change. Our analysis describes what is needed to deliver the ‘left shift’ and ‘earned autonomy’ called for in Lord Darzi’s review.9
But, even more importantly, our work offers the potential to re-engage and re-motivate10 GPs across our discipline, whatever their contractual status, career stage, or scope of practice. The definition recognises the core value of our shared work; and our analysis describes the skills and resources we should rightly expect to do that work. Together, they support us in reconnecting a profession that extends across the RCGP community.
Together, we can stand up for general practice.
Notes
Provenance
Freely submitted; not externally peer reviewed.
Competing interests
Joanne Reeve receives royalties from Medical Generalism, Now! Gail Allsopp is Chief Medical Advisor to the Department for Work and Pensions and Honorary Associate Professor at the University of Nottingham.
- © British Journal of General Practice 2025
