Are changes needed in the content of general practice?

The content of general practice (GP) is changing. The concepts of polypharmacy and multimorbidity, particularly among older patients, are becoming common in our practice as well as being the focus of research among our GP colleagues.[1–5] Furthermore, calls for screening and diagnosing that do not actually help our patients are increasingly an issue brought up in our clinical work. Words like medicalization, overdiagnosing and overdetec-tion are hot topics in GP. So, once again it is time to pause and reflect on the content of GP, what needs to be changed and what components in our work are still strong and robust, and hence can be used without modification. The Wonca Europe conference 2016 was held in Copenhagen last June. Among the keynote speakers who gave presentations was Professor Martin Marshall, from University College London, UK. In his presentation, he talked about how GP needs to change as well as about the ways in which it does not need to change. In his opinion, providing continuity of care, providing personal care and care that patients want and expect from GP do not need to change. However, he said: " In order to provide these general aspects of GP, we are going to need to change, with general practitioners (GPs) needing to take greater responsibility for the way the system runs ". He stated three important areas that need to be addressed and changed so that GPs would continue to provide the general aspects of GP. Firstly, he pointed out that GPs focus strongly on individual patient needs, though they are indeed also very good at keeping abreast of the whole health system. Thus, the conclusion must be that GPs should participate more in discussions and decision-making on how the health system in which they work should operate. Secondly, Professor Marshall spoke about uncertainty in our work. " Although we often think we know exactly what we are doing, for example what blood pressure value to aim for and what diabetes control to aim for, the reality is that much of what GPs do is uncertain. Our job as GPs is to manage this uncertainty. We must be more explicit in that role and much better in making that part a central part of our function ". This topic of uncertainty in GPs work is very interesting and the question arises as to how many medical doctors have chosen not to work …