TY - JOUR T1 - Redefining quality: valuing the role of the GP in managing uncertainty JF - British Journal of General Practice JO - Br J Gen Pract SP - e146 LP - e148 DO - 10.3399/bjgp16X683773 VL - 66 IS - 643 AU - Martin Marshall Y1 - 2016/02/01 UR - http://bjgp.org/content/66/643/e146.abstract N2 - Less than half of the problems that patients present to their GP can be understood in terms of recognised disease processes.1 The growing propensity to reward — and therefore preferentially place value on — the management of well-defined diseases only partially reflects the nature of what GPs do. Rewarding what can be easily measured has resulted in a number of significant changes to how GPs work: they have become more structured in the ways that they deliver care, more focused on the scientific evidence, and more willing to engage with systematic improvement interventions, such as guidelines, incentives, and performance management.2 It does, however, have unintended consequences that are beginning to have a negative impact on quality of care.The problem is the failure to recognise the essential role of GPs in dealing with the large proportion of presentations that are uncertain, ambiguous, or frankly paradoxical. The complexity and multi-dimensionality of general practice has long been recognised3–6 and is enshrined in popular working definitions of the discipline.6 Nevertheless, the incentives to focus narrowly on technical dimensions of quality, such as clinical effectiveness, accessibility, safety, and efficiency, are becoming more pronounced. Even though GPs spend much of their time operating at the margins of well-defined problems, this role is too often regarded as discretionary. As a consequence it is being crowded out in a system that barely has the capacity to deliver the established ‘must-dos’.I am going to explore the importance of the role of the GP in dealing with uncertainty. Drawing on a case study I will illustrate how the problems that people present often operate at the boundaries between conventional categorisations;4 I will then suggest ways of improving the understanding and raising the profile of these activities so that their contribution to … ER -