Also termed family doctor or family practitioner, he or she is a doctor working in primary care, acting as the first port of professional contact for most patients in the NHS. There are approximately 35,000 GPs in the UK, and their services are accessed by registering with a GP practice – usually called a surgery or health centre. Patients should be able to see a GP within 48 hours, and practices have systems to try to ensure that urgent problems are dealt with immediately. GPs generally have few diagnostic or treatment facilities themselves, but can use local hospital diagnostic services (X-rays, blood analysis, etc) and can refer or admit their patients to hospital, where they come under the supervision of a CONSULTANT. GPs can prescribe nearly all available medicines directly to their patients, so that they treat 90 per cent of illnesses without involving specialist or hospital services.
Most GPs work in groups of self-employed individuals, who contract their services to the local CLINICAL COMMISSIONING GROUP (CCG), itself under the supervision of GPs – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees of rather than partners in a practice. Alternatively, they might be salaried employees of a CCG. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions as well as recognising conditions that require specialist help, especially those requiring urgent action.
Practices rather than individual GP's share the responsibility to patients during normal working hours. After 6.30 p.m. and until 8.00 a.m., Mondays to Fridays, out-of-hours primary care has become the responsibility of CCGs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. National telephone advice services in the constituent countries of the UK offer an opportunity for patients to contact an adviser who guides the caller, using a computerised algorithm, on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of these services is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance staff and hospital facilities although since their introduction, emergency attendances at hospitals have risen considerably.
Training for NHS general practice after qualification and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This final year exposes registrars to life as a GP, where they start to look after their own patients while still being closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – qualifies registrars to become GPs in their own right, and many newly qualified GPs also sit the membership exam set by the Royal College of General Practitioners.
A growing number of GP practices offer educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also offering them allocated time to learn clinical skills away from the more specialist environment of the hospital.
In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; OCCUPATIONAL MEDICINE; family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.
NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).
Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form CCGs. Most have a membership of about 30 GPs, working within a defined geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some also run ambulance services.
One of the roles of CCGs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to influence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between different GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.
One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. CCGs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they offer their patients.