Wednesday, May 31, 2023

Battle to retain GPs: defining “generalism” is key

We previously emphasised that undergraduate training in general practice is critical for retaining general practitioners.1 In addition, upstream training in “community generalism” is essential for a resilient and sustainable GP workforce.The distinction between “community” and “hospital” generalism lies in the approach to clinical investigations.2 Hospital generalists must use tests to identify causes, exclude major diseases, and eliminate uncertainty. In community generalism, serious conditions are uncommon, and illness of a transient, psychosocial, or unexplained nature is more prevalent. In this lower risk population, tests are often unhelpful and might sow anxiety or greater uncertainty. Negotiating management plans with patients is, therefore, key. This calls for triage, reliance on history and examination, and use of strategic principles (such as incremental management).3Community generalists must be comfortable recognising the “well” patient and promoting non-pharmacological care, well judged restraint, “time as a tool,” “trial of treatment,” and safety netting.3 Instead of factual recall, community generalists…

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