'Contract needs to change to promote holistic care', says RCGP Scotland

The GP contract needs to change if doctors are to embrace a more biographical and holistic approach to patient care.

Dr Gillies: Current GP contract is additional obstacle to use of biographical practice (Photograph: Haymarket/Peter Hill)
Dr Gillies: Current GP contract is additional obstacle to use of biographical practice (Photograph: Haymarket/Peter Hill)

Dr John Gillies, chair of RCGP Scotland, said good practice involved an integration of biotechnical and biographical perspectives.

He described the biotechnical approach as objective – one that applies evidence to diseases in silos, and uses pharmacology as a main resource.

A biographical perspective is more subjective, evidence-informed and holistic, and makes use of health professionals’ time, often instead of drugs.

Dr Gillies said the current GP contract was an additional obstacle to the greater use of biographical practice.

The QOF promoted and rewarded the biotechnical approach, which is easy to measure, he said. ‘We have devised a system that rewards access not continuity in the UK. So we need to look at the contractual framework,’ said Dr Gillies.

Professor George Freeman, emeritus professor of general practice at Imperial College London, said an holistic approach, which places a health problem in the context of a patient’s life, was a valuable facet to medicine.

‘GPs may lack some of the detailed technical expertise of specialists, but maybe we can make up for it by knowing the biography and context,’ he said.

But this could be jeopardised by a lack of continuity of care in modern general practice caused by an increase in part-time working and the use of locums who were not able to develop the same relationship and knowledge about patients.

Prof Freeman said that the Netherlands had developed a buddy system to address this problem, which helped maintain continuity.

‘They have a very clear stance on part-time working. They say that the patient should not have to relate to more than two GPs in the practice and when you sign up with a practice as a part-time doctor, you are assigned a buddy,’ he said.

Edinburgh GP Dr Catriona Morton said the contract needed to be updated to ensure poverty that led to ill health was tackled.

‘Our contract is almost a decade old and we need to refashion it,’ she said.

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