Joanne Reeve is a GP, Professor of Primary Care, and leads the @wisegpcouk programme. She is on Twitter: @joannelreeve
We won’t address our workforce crisis by just doing more of the same. Expanding both existing training programmes and recruitment and retention schemes with the same offer won’t work because it is the job itself that is contributing to the crisis.1 We urgently need to reform the job of general practice.
I have long argued that we must update professional training, practice design, and healthcare policy to better recognise and support the distinct role that GPs are uniquely placed to offer in primary medical care — the practice of advanced generalist medicine.2
In my 20 years of studying medical generalism, I have seen it being designed out of medical practice, teaching, and healthcare policy. I have witnessed and researched the negative impact of these changes on patients, professionals, and healthcare delivery. So, in response, I now lead and help deliver work to restore and reclaim the wisdom of general and generalist practice through WiseGP. At the heart of that work is a goal to recognise and restore the distinct knowledge work of general and generalist practice.
So what do I mean? Knowledge work is the work we do to make sense of and deal with the complex problems we see in daily practice — the things that can’t be neatly placed into a pathway, protocol, or algorithm.3 In other words, the essence of what we do — every day.
“… knowledge workers are a prized asset … a necessary resource if organisations are to meet complex goals.”
Knowledge workers need to know a lot, but more importantly they must have the skills to critically and creatively adapt and apply what they know in context.4 Knowing the latest guidelines on hypertension management, for example, isn’t enough. They must also have the skills, confidence, and practice-level support necessary to decide if, when, and how to apply what they know to meet the needs of the person sat in front of them.
In other sectors, knowledge workers are a prized asset5 — recognised as a necessary resource if organisations are to meet complex goals. The World Economic Forum recently described that the two most important skills for future workers are creative thinking and analytical thinking.6 My research has shown that developing skills and confidence in knowledge work is an important motivator for professional practice.7 Yet in general practice there is a relentless trend to replace knowledge workers with so-called information workers. GPs are increasingly contracted to simply collect the information required by externally defined goals, and package it up to be processed and analysed elsewhere — whether by a digital algorithm or faceless referral pathway.
Take the example of a patient presenting with the effects of long COVID. As an advanced generalist clinician and a skilled knowledge worker, I work with my patient to explore their problems, co-construct an explanation that guides a management plan, put that into action, and then meet to evaluate and — if necessary — amend that plan. This is advanced generalist practice, a GP role that is too often unrecognised and so undervalued by healthcare contracts and systems.
“… in general practice there is a relentless trend to replace knowledge workers with so-called information workers.”
Suppose my patient and I recognise that they need additional help that is unavailable in primary care (for example, speech therapy), then I refer. However, my referral is rejected because ‘the chest X-ray result is 1 week out of date’. My detailed letter outlining my generalist assessment (my knowledge work) has been ignored. Instead, I have been treated as an information worker, my work rejected, and my referral refused. Both I, and my patient, are left frustrated and demoralised.
We urgently need to reverse the relentless trend to undermine the knowledge work of general practice in the interests of patients and practitioners alike. I set up WiseGP to do just that. My new book, Medical Generalism, Now! describes a blueprint for action. With multiple partners, we are implementing work to champion, build, and sustain the knowledge work of frontline general practice.8 We run the CATALYST programme to tackle professional development;7 we are changing practice set up within the TIMES project;9 and our national WiseGP programme brings together key voices and resources for change.
Tackling the workforce crisis and reclaiming general practice needs the collective action and voice of the profession. We need this voice to be visible in the policy conversations happening in integrated care boards and healthcare organisations around the NHS, as well as in the manifesto pledges that will be emerging in the coming months. So, we will shortly be launching a WiseGP Action Group. Sign up for our WiseGP newsletter to hear how you can join the group and become part of the work to reclaim general practice.
1. Andah E, Essang B, Friend C, et al. Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review. BJGP Open 2021; DOI: https://doi.org/10.3399/BJGPO.2021.0005.
2. Reeve J. Medical generalism, now! Reclaiming the knowledge work of modern practice. Boca Raton, FL: CRC Press, 2023.
3. WiseGP. Puzzled by knowledge work? https://www.wisegp.co.uk/post/puzzled-by-knowledge-work (accessed 16 Nov 2023).
4. Gabbay J, le May A. Knowledge transformation in health and social care: putting mindlines to work. Oxon: Routledge, 2023.
5. Corporate Finance Institute. Knowledge workers. https://corporatefinanceinstitute.com/resources/valuation/knowledge-workers (accessed 16 Nov 2023).
6. Masterson V. Future of jobs 2023: these are the most in-demand skills now — and beyond. 2023. https://www.weforum.org/agenda/2023/05/future-of-jobs-2023-skills (accessed 16 Nov 2023).
7. Hull York Medical School. Revolutionising career development for new general practitioners. https://hyms.ac.uk/research/stories/revolutionising-career-development-for-new-general-practitioners (accessed 16 Nov 2023).
8. WiseGP. Reclaiming general practice. https://www.wisegp.co.uk/post/reclaiming-general-practice (accessed 16 Nov 2023).
9. Hull York Medical School. Study paves the way to improve tailored care for people living with dementia and sleep problems. https://hyms.ac.uk/research/stories/study-paves-the-way-to-improve-tailored-care-for-people-living-with-dementia-and-sleep-problems (accessed 16 Nov 2023).