Perhaps we can characterise these two kinds of practice as representing either efficiency in providing a high volume of appointments or effectiveness in making each appointment count for more... Ben Hoban reflects.
The introduction of new roles working alongside GPs should improve access, quality and contain costs in health care, but these new roles cannot fill the skill gaps left by the shortage of GPs. Terry Kemple looks at the evidence.
General Practice has been diluted by demand and lost all flavour. Young doctors have no taste for it and, with the NHS in free-fall, we need to now undertake some fundamental changes. John Havard and colleagues offer a gin and tonic themed
The ARRS is a big step change for how practice teams work to manage their patients and appointments, and it’s naïve to think that implementation of such a wide-ranging scheme wouldn’t have significant impacts and unanticipated consequences for the wider workforce.
...requests for race-based concordance is a complicated area of medicine, and it is one that is not easily dealt with through formulised policies. Instead, well-reasoned judgements by the care team through a deliberative process, that begin with ethical frameworks, might provide a
nappropriate transfer of workload can go both ways, and it can feel highly frustrating for GPs and hospital specialists alike. But as patient care becomes increasingly fragmented, thinking locally about how to improve collaborative care might help build back those relationships across
The RCGP is again also calling for a merger of the general practice and specialist registers. What’s the background to this, and what might it mean to rebrand GPs as consultants?
With the combination of a global pandemic, cost-of-living crisis and the Government’s austerity measures, over the last few years rates of DA are thought to have increased significantly. Paul McNamara and Anna de Natale reflect on how general practice should respond.
Domestic abuse remains a largely concealed phenomenon. It affects healthcare professionals (HCPs), especially women, nurses, and those working in low- and middle-income countries, at an alarmingly disproportionate rate. Vasumathy Sivarajasingam asks us be mindful of its causes and effects.
Esoteric morality refers to the idea that it might sometimes be right to do or recommend privately actions that it would be wrong to advocate openly, if doing so secretly would have better overall consequences. Richard Armitage asks what this might mean
In this provocative essay, Richard Armitage explores what a respect for autonomy requires of GPs, its manifestation as the patient’s ‘right’ not to know, and the problems this raises for contemporary general practice.
Billed as ‘seven steps to save general practice and safeguard our NHS’, the manifesto reflects the policies the RCGP believes political parties need to take on board to ‘save’ general practice ahead of the next general election. Nada Khan does some unpicking...
Peter McNelly is a mental health nurse and David Fowler is a practice manger in Northern Ireland. They argue that mental health practitioners can be a valuable addition to the multidisciplinary team, if sensibly recruited and deployed.
The General Medical Council’s requirement in its updated guidance Good Medical Practice for doctors to be kind has caused some consternation. How does being kind fit into a professional framework, and is it a luxury or a necessity? Ben Hoban reflects.
People with chronic pain need personalised care – an approach offering patients choice and control over their mental and physical health, basing care on what matters to them personally, and focusing on individual strengths and needs. It is possible.
The way we talk about mental ill health can end up creating a linguistic black box which we see but cannot see inside. How then can we know what to expect from our distressed patients, and how best to help them? Ben
This issue focusses on the heart and cardiovascular medicine. Life and Times for its part stresses the metaphysical and metaphorical heart with an eclectic smorgasbord of useful, challenging, and entertaining articles. This includes learning from tragedy, a tongue in cheek glossary, and
In Medical Generalism—Now!, Joanne Reeve extends her concept of the creative self. And she argues that the fundamental challenge for the contemporary primary care clinician is to honour the patient’s creative abilities and provide the kind of flexible, tailored care that allows
Primary care mental health is a fundamental part of general practice, delivering care to many more people than specialist mental health services, and yet there is limited documented history of its development. We sought to address this gap in the narrative by
As a GP and medical student... we wanted to see whether patients experience experiencing homelessness could also reap the benefits of nature prescriptions.
'A relational way of working, thinking and designing is one that creates possibility for change, one that creates abundance – our capacity for relationships, like love, is infinite.’ Emilie Couchman reviews a call for radical reform
Maladaptive daydreaming is a relatively new concept in the field of psychology experienced by an estimated 2.5% of the population. Sara Noden analyses this proposed mental disorder and the implications for clinicians.
Lucy Chiddick argues that promoting school attendance is a complex task, best done by those with appropriate expertise. Where GPs engage with the issue there should be appropriate time and care, recognising that there are many drivers of absenteeism and that attendance
Ilyich’s life story made me reflect on the extent to which I'm satisfied with my own life...I've often asked the question that Tolstoy confronts his readers with here: is there more to life than this? Luke Allen reviews this classic novella.
The shocking infant murders by nurse Lucy Letby represent a mercifully rare (we think) class of event. These remain extremely difficult to understand, predict or prevent, much as we must try. David Zigmond reflects on the role of commercially corporatised healthcare culture
Why hasn’t the approach of Centene and Babylon worked? And what’s the history behind corporate acquisition of GP surgeries? Nada Khan investigates.
If we look at continuity without considering the wider context of general practice, we may find ourselves being swept out to sea as we gaze longingly back at the beach. Ben Hoban helps us to reflect on the really useful elements of
Vasumathy Sivarajasingam explores domestic abuse PUNs and DENs as a relevant appraisal topic linked to mandatory safeguarding, with links to learning materials, legislation and further articles.
With the potential dismantling of the GP partnership model and the drive for a multiprofessional workforce in primary care, is this the right time to look at shared leadership as a facilitator of positive change?
"The function of a diagnosis is more than to guide treatment planning. It often provides emotional relief for patients, even if the diagnosis is dire. As Susan put it, “I keep hoping that some doctor will tell me exactly what this ‘skin
The title, ‘What is a doctor?’, neatly articulates a contemporary query. As the multidisciplinary team (MDT) becomes increasingly complex with additional moving parts, the role of the doctor becomes ever more difficult to describe. The memory of the ‘family doctor’ is fading.
In clinic last week, a patient called me by my first name – this was the first time I have experienced this in primary care, and for some reason I found it quite jarring. ...there seems to be very little evidence on
Merope Mills’ description of the death of Martha, her 13 year old daughter, is a raw and harrowing account of the mistakes doctors made that led to Martha’s deterioration and ultimately her death. Nada Khan evaluates the concept of a Martha’s rule,
As part of a Student Selected Component focussing on frailty in primary care, supervised by Paul McNamara, Scott Wylie had the chance to learn directly from GPs and attending local frailty services. As part of the project, he also carried out an
What can patients who recall their experience of death during a cardiac arrest tell us about consciousness? Armando Henrique Norman explores
I had progressed from A-Levels into becoming a GP... without pausing for breath - or allowing time for the aspect of my professional practice I enjoyed the most; teaching. But not clinical or consultation skills; instead, anatomy.
As our NHS shows increasing signs of its own sickness, many are calling for more funds, staffing, and technology. These may be necessary but are certainly not sufficient. What else of importance are we missing?
"I was very impressed by all those professionals working hard to make a difference for other people. I recognised myself in so many of the patient experiences described." – Elke Hausmann provides an overview of the 'Long COVID: what needs to happen
Why do people consult medial opinion? Alex Burrell looks at a classic paper on the the 5 triggers to seeking medical advice.
Tim Sanders views the “rewiggling” of the Swindale Beck in the Lake District as a metaphor for a need to nurture and cherish core aspects of generalism, continuity and relationship-based care within the role of the GP
So, how can GPs help their patients in facing transformative decisions? The advice, helpfully explained by Richard Armitage, is to reframe the decision-making process with which we approach them.