Family medicine is a medical
specialty within
primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
that provides continuing and comprehensive health care for the individual and family across all ages, genders,
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
s, and parts of the body. The specialist, who is usually a
primary care physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...
, is named a family physician. It is often referred to as
general practice
General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be describe ...
and a practitioner as a
general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on
disease prevention
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
and
health promotion
Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."
Scope
The WHO's 1986 Ottawa Charter for Healt ...
. According to the
World Organization of Family Doctors
The World Organization of Family Doctors (WONCA) is a global not-for-profit professional organization representing family physicians and general practitioners from all regions of the world. WONCA's mission is to improve the quality of life of the ...
(WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as
primary care ethics
Primary care ethics is the study of the everyday decisions that primary care clinicians make, such as: how long to spend with a particular patient, how to reconcile their own values and those of their patients, when and where to refer or investig ...
.
Scope of practice
Family physicians in the United States must hold either an
M.D.
Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. T ...
or a
D.O.
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...
degree. Physicians who specialize in family medicine must successfully complete an accredited three or four year long family medicine
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgrad ...
in the United States in addition to their medical degree. They are then eligible to sit for a
board certification
Board certification is the process by which a physician or other professional demonstrates a mastery of advanced knowledge and skills through written, practical, or simulator-based testing.
Certification bodies
There are more than 25 boards that ...
examination, which is now required by most hospitals and health plans.
American Board of Family Medicine
The American Board of Family Medicine (ABFM) is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties. Founded in February 1969 as the American Board of Family Practice (ABFP) ...
requires its diplomates to maintain certification through an ongoing process of
continuing medical education, medical knowledge review, patient care oversight through chart audits, practice-based learning through quality improvement projects and retaking the board certification examination every 7 to 10 years. The
American Osteopathic Board of Family Physicians
The American Osteopathic Board of Family Physicians (AOBFP) is an organization that provides board certification to qualified osteopathic physicians (D.O.) who specialize in delivering comprehensive primary care for patients of all ages, genders, ...
requires its diplomates to maintain certification and undergo the process of recertification every 8 years.
Physicians certified in family medicine in
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
are certified through the
College of Family Physicians of Canada
The College of Family Physicians of Canada (CFPC; French: ''Collège des médecins de famille du Canada'', ''CMFC'') is a professional association and the legal certifying body for the practice of family medicine in Canada. This national organiz ...
, after two years of additional education. Continuing education is also a requirement for maintenance of certification.
The term "family medicine" or "family physician" is used in the United States, Mexico, South America, many European and Asian countries. In
Sweden
Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...
, certification in family medicine requires five years working with a tutor, after the medical degree. In
India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
, those who want to specialize in family medicine must complete a three-year family medicine residency, after their medical degree (MBBS). They are awarded either a D.N.B. or an M.D. in family medicine. Similar systems exist in other countries.
General practice is the term used in many other nations, such as the United Kingdom, Australia, New Zealand, and South Africa. Such services are provided by
general practitioners. The term ''primary care'' in the UK may also include services provided by community pharmacy,
optometrist
Optometry is a specialized health care profession that involves examining the eyes and related structures for defects or abnormalities. Optometrists are health care professionals who typically provide comprehensive primary eye care.
In the Uni ...
, dental surgery and community hearing care providers. The balance of care between primary care and secondary care - which usually refers to hospital based services - varies from place to place, and with time. In many countries there are initiatives to move services out of hospitals into the community, in the expectation that this will save money and be more convenient.
Family physicians deliver a range of acute, chronic, and preventive medical care services. In addition to diagnosing and treating illness, they also provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and personalized counselling on maintaining a healthy lifestyle. Family physicians also manage chronic illness, often coordinating care provided by other sub-specialists. Many American Family Physicians deliver babies and provide prenatal care. In the U.S., family physicians treat more patients with back pain than any other physician sub-specialist, and about as many as
orthopedists and
neurosurgeons
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
combined.
Family medicine and family physicians play a vital role in the healthcare system of a country. In the U.S. for example, nearly one in four of all office visits are made to family physicians. That is 208 million office visits each year — nearly 83 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty.
In Canada
Education and training
In Canada, aspiring family physicians are expected to complete a residency in family medicine from an accredited university after obtaining their
Doctor of Medicine
Doctor of Medicine (abbreviated M.D., from the Latin language, Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a profes ...
degree. Although the residency usually has a duration of two years, graduates may apply to complete a third year, leading to a certification from the
College of Family Physicians of Canada
The College of Family Physicians of Canada (CFPC; French: ''Collège des médecins de famille du Canada'', ''CMFC'') is a professional association and the legal certifying body for the practice of family medicine in Canada. This national organiz ...
in disciplines such as
emergency medicine
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...
,
palliative care
Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
,
care of the elderly
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often called re ...
,
sports and exercise medicine, and
women's health
Women's health differs from that of men in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization as "a state of complete physical, mental and social well-being and not mer ...
, amongst others.
In some institutions, such as
McGill University
McGill University (french: link=no, Université McGill) is an English-language public research university located in Montreal, Quebec, Canada. Founded in 1821 by royal charter granted by King George IV,Frost, Stanley Brice. ''McGill Universit ...
in
Montreal
Montreal ( ; officially Montréal, ) is the List of the largest municipalities in Canada by population, second-most populous city in Canada and List of towns in Quebec, most populous city in the Provinces and territories of Canada, Canadian ...
, graduates from family medicine residency programs are eligible to complete a
master's degree
A master's degree (from Latin ) is an academic degree awarded by universities or colleges upon completion of a course of study demonstrating mastery or a high-order overview of a specific field of study or area of professional practice. and a
Doctor of Philosophy
A Doctor of Philosophy (PhD, Ph.D., or DPhil; Latin: or ') is the most common Academic degree, degree at the highest academic level awarded following a course of study. PhDs are awarded for programs across the whole breadth of academic fields ...
(Ph.D.) in family medicine, which predominantly consists of a research-oriented program.
In the United States
History of medical family practice
Concern for family health and medicine in the United States existed as far back as the early 1930s and 40s. The American public health advocate
Bailey Barton Burritt
Bailey Barton Burritt (31 May 1878 – 18 June 1954) was a United States public health and social welfare advocate known as "the father of the family health movement." He was the chairman of the executive council of the Community Service Society. ...
was labeled "the father of the family health movement" by ''
The New York Times
''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...
'' in 1944.
Following
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
, two main concerns shaped the advent of family medicine. First, medical specialties and subspecialties increased in popularity, having an adverse effect on the number of physicians in general practice. At the same time, many medical advances were being made and there was concern within the "
general practitioner" or "GP" population that four years of medical school plus a one-year internship was no longer adequate preparation for the breadth of medical knowledge required of the profession.
Many of these doctors wanted to see a residency program added to their training; this would not only give them additional training, knowledge, and prestige but would allow for board certification, which was increasingly required to gain hospital privileges.
In February 1969, family medicine (then known as family practice) was recognized as a distinct specialty in the U.S. It was the twentieth specialty to be recognized.
Education and training
Family physicians complete an undergraduate degree,
medical school
A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, M ...
, and three more years of specialized
medical residency
Residency or postgraduate training is specifically a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS, MBChB), veterinarian ( DVM or VMD) , dentist ( DDS or DMD) or podiatrist ( ...
training in family medicine. Their residency training includes rotations in
internal medicine,
pediatrics
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...
,
obstetrics-gynecology,
psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psych ...
,
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
,
emergency medicine
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...
, and
geriatrics
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek language, Greek γέρων ''geron'' meaning "old man", and ιατ ...
, in addition to electives in a wide range of other disciplines. Residents also must provide care for a panel of continuity patients in an outpatient "model practice" for the entire period of residency. The specialty focuses on treating the whole person, acknowledging the effects of all outside influences, through all stages of life. Family physicians will see anyone with any problem, but are experts in common problems. Many family physicians deliver babies in addition to taking care of patients of all ages.
In order to become
board certified
Board certification is the process by which a physician or other professional demonstrates a mastery of advanced knowledge and skills through written, practical, or simulator-based testing.
Certification bodies
There are more than 25 boards that ...
, family physicians must complete a residency in family medicine, possess a full and unrestricted medical license, and take a written cognitive examination. Between 2003 and 2009, the process for maintenance of board certification in family medicine is being changed (as well as all other
American Specialty Boards) to a series of yearly tests on differing areas. The
American Board of Family Medicine
The American Board of Family Medicine (ABFM) is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties. Founded in February 1969 as the American Board of Family Practice (ABFP) ...
, as well as other specialty boards, are requiring additional participation in continuous learning and self-assessment to enhance clinical knowledge, expertise and skills. The Board has created a program called the "Maintenance of Certification Program for Family Physicians" (MC-FP) which will require family physicians to continuously demonstrate proficiency in four areas of clinical practice: professionalism, self-assessment/lifelong learning, cognitive expertise, and performance in practice. Three hundred hours of
continuing medical education within the prior six years is also required to be eligible to sit for the exam.
Family physicians may pursue
fellowships in several fields, including
adolescent medicine,
geriatric medicine
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros' ...
,
sports medicine
Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...
,
sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
,
hospital medicine
Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hos ...
and
hospice and palliative medicine
In 2006, ''hospice and palliative medicine'' was officially recognized by the American Board of Medical Specialties, and is ''co-sponsored'' by the American Boards of
* Internal Medicine
* Anesthesiology
* Family Medicine
* Physical Medicine ...
. The American Board of Family Medicine and the American Osteopathic Board of Family Medicine both offer
Certificates of Added Qualifications (CAQs) in each of these topics.
Shortage of family physicians
Many sources cite a shortage of family physicians (and also other primary care providers, i.e. internists, pediatricians, and general practitioners). The per capita supply of primary care physicians has increased about 1 percent per year since 1998.
A recent decrease in the number of M.D. graduates pursuing a residency in primary care has been offset by the number of
D.O. graduates and
graduates of international medical schools (IMGs) who enter primary care residencies.
Still, projections indicate that by 2020 the demand for family physicians will exceed their supply.
The number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.
In 2006, when the nation had 100,431 family physicians, a workforce report by the
American Academy of Family Physicians
The American Academy of Family Physicians (AAFP) was founded in 1947 to promote and maintain high-quality standards for family medicine, an offshoot of the classical general practitioner. It is headquartered in Leawood, Kansas.
AAFP is one of ...
indicated the United States would need 139,531 family physicians by 2020 to meet the need for primary medical care. To reach that figure 4,439 family physicians must complete their residencies each year, but currently, the nation is attracting only half the number of future family physicians that will be needed.
To address this shortage, leading family medicine organizations launched an initiative in 2018 to ensure that by 2030, 25% of combined US allopathic and osteopathic medical school seniors select family medicine as their specialty.
The initiative is termed the “25 x 2030 Student Choice Collaborative,” and the following eight family medicine organizations have committed resources to reaching this goal:
*
American Academy of Family Physicians
The American Academy of Family Physicians (AAFP) was founded in 1947 to promote and maintain high-quality standards for family medicine, an offshoot of the classical general practitioner. It is headquartered in Leawood, Kansas.
AAFP is one of ...
* American Academy of Family Physicians Foundation
*
American Board of Family Medicine
The American Board of Family Medicine (ABFM) is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties. Founded in February 1969 as the American Board of Family Practice (ABFP) ...
*
American College of Osteopathic Family Physicians
The American College of Osteopathic Family Physicians (ACOFP) is a professional association and a medical specialty college in the United States. Its membership consists of osteopathic physicians who practice family medicine, residents and medical ...
* Association of Departments of Family Medicine
* Association of Family Medicine Residency Directors
* North American Primary Care Research Group
*
Society of Teachers of Family Medicine
The waning interest in family medicine in the U.S. is likely due to several factors, including the lesser prestige associated with the specialty, the lesser pay, and the increasingly frustrating practice environment. Salaries for family physicians in the United States are lower than average for physicians, with the average being $225,000.
However, when faced with debt from medical school, most medical students are opting for the higher-paying specialties. Potential ways to increase the number of medical students entering family practice include providing relief from medical education debt through loan-repayment programs and restructuring fee-for-service reimbursement for health care services. Family physicians are trained to manage acute and chronic health issues for an individual simultaneously, yet their appointment slots may average only ten minutes.
In addition to facing a shortage of personnel, physicians in family medicine experience some of the highest rates of burnout among medical specialties, at 47 percent.
Current practice
Most family physicians in the US practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. However, the specialty is broad and allows for a variety of career options including education, emergency medicine or urgent care, inpatient medicine, international or wilderness medicine, public health, sports medicine, and research. Others choose to practice as consultants to various medical institutions, including insurance companies.
United Kingdom
History of general practice services
The pattern of services in the UK was largely established by the
National Insurance Act 1911
The National Insurance Act 1911 created National Insurance, originally a system of health insurance for industrial workers in Great Britain based on contributions from employers, the government, and the workers themselves. It was one of the foun ...
which established the list system which came from the
friendly societies
A friendly society (sometimes called a benefit society, mutual aid society, benevolent society, fraternal and service organisations, fraternal organization or Rotating savings and credit association, ROSCA) is a mutual association for the purpo ...
across the country. Every patient was entitled to be on the list, or panel of a general practitioner. In 1911 that only applied to those who paid
National insurance contribution
National Insurance (NI) is a fundamental component of the welfare state in the United Kingdom. It acts as a form of social security, since payment of NI contributions establishes entitlement to certain state benefits for workers and their famili ...
s. In 1938, 43% of the adult population was covered by a panel doctor. When the National Health Service was established in 1948 this extended to the whole population. The practice would be responsible for the
patient record which was kept in a "Lloyd George envelope" and would be transferred if necessary to another practice if the patient changed practice. In the UK, unlike many other countries, patients do not normally have direct access to hospital consultants and the GP controls access to secondary care.
![GP records in envelopes](https://upload.wikimedia.org/wikipedia/commons/c/c3/GP_records_in_envelopes.jpg)
Practices were generally small, often single handed, operating from the doctor's home and often with the doctor's wife acting as a receptionist. When the NHS was established in 1948 there were plans for the building of
health centre
A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. Typical services covered are family pr ...
s, but few were built.
In 1953, general practitioners were estimated to be making between 12 and 30 home visits each day and seeing between 15 and 50 patients in their surgeries.
Current practice
Today, the services are provided under the
General Medical Services Contract
General medical services (GMS) is the range of healthcare that is provided by general practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are e ...
, which is regularly revised.
599 GP practices closed between 2010–11 and 2014–15, while 91 opened and average practice list size increased from 6,610 to 7,171. In 2016 there were 7,613 practices in England, 958 in Scotland, 454 in Wales and 349 in Northern Ireland. There were 7,435 practices in England and the average practice list size in June 2017 was 7,860. There were 1.35 million patients over 85. There has been a great deal of consolidation into larger practices, especially in England.
Lakeside Healthcare Lakeside Healthcare Groupwhich operates from a number of sites across Cambridgeshire, Lincolnshire and Northamptonshire, is one of the biggest General practice / Primary Care Providers in the National Health Service with 80 partners and almost 200,0 ...
was the largest practice in England in 2014, with 62 partners and more than 100,000 patients. Maintaining general practices in isolated communities has become very challenging, and calls on very different skills and behaviour from that required in large practices where there is increasing specialization. By 1 October 2018, 47 GP practices in England had a list size of 30,000 or more and the average list size had reached 8,420. In 2019 the average number of registered patients per GP in England has risen since 2018 by 56 to 2,087.
The
British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
in 2019 conducted a survey for GP premises. About half of the 1,011 respondents thought their surgeries were not suitable for present needs, and 78% said they would not be able to handle expected future demands.
Under the pressure of the
Coronavirus
Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the com ...
epidemic in 2020 general practice shifted very quickly to remote working, something which had been progressing very slowly up to that point. In the
Hurley Group Clare Gerada
Dame Clare Mary Louise Francis Gerada, Lady Wessely, (born November 1959) is a London-based general practitioner who is President of the Royal College of General Practitioners (RCGP) and a former chairperson of the RCGP Council (2010–2013) ...
reported that "99% of all our work is now online" using a digital triage system linked to the patient's
electronic patient record
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared throu ...
which processes up to 3000 consultations per hour. Video calling is used to “see” patients if that is needed.
In 2019 according to
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
, almost 90% of salaried GPs were working part-time.
England
The GP Forward View, published by
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
in 2016 promised £2.4 billion (14%) real-terms increase in the budget for general practice.
Jeremy Hunt
Jeremy Richard Streynsham Hunt (born 1 November 1966) is a British politician who has served as Chancellor of the Exchequer since 14 October 2022. He previously served in the Cabinet as Secretary of State for Culture, Olympics, Media and Sport ...
pledged to increase the number of doctors working in general practice by 5,000. There are 3,250 trainee places available in 2017. The GP Career Plus scheme is intended to retain GPs aged over 55 in the profession by providing flexible roles such as providing cover, carrying out specific work such as managing long-term conditions, or doing home visits. In July
Simon Stevens
Simon Laurence Stevens, Baron Stevens of Birmingham, (born 4 August 1966) is a British public policy adviser, former CEO, and independent member of the UK House of Lords. He served as the eighth Chief Executive of the National Health Service ...
announced a programme designed to recruit around 2,000 GPs from the EU and possibly New Zealand and Australia. According to
NHS Improvement
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers to ...
a 1% deterioration in access to general practice can produce a 10% deterioration in emergency department figures.
GPs are increasingly employing
pharmacist
A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
s to manage the increasingly complex medication regimes of an aging population. In 2017 more than 1,061 practices were employing pharmacists, following the rollout of
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
’s Clinical Pharmacists in General Practice programme. There are also moves to employ care navigators, sometimes an enhanced role for a receptionist, to direct patients to different services such as pharmacy and physiotherapy if a doctor is not needed. In September 2017 270 trained care navigators covering 64,000 patients had been employed across
Wakefield
Wakefield is a cathedral city in West Yorkshire, England located on the River Calder. The city had a population of 99,251 in the 2011 census.https://www.nomisweb.co.uk/census/2011/ks101ew Census 2011 table KS101EW Usual resident population, ...
. It was estimated that they had saved 930 GP hours over a 10-month trial.
Four
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s:
Northumbria Healthcare NHS Foundation Trust
Northumbria Healthcare NHS Foundation Trust is an NHS foundation trust which provides hospital and community health services in North Tyneside and hospital, community health and adult social care services in Northumberland.
History
The trust ...
;
Yeovil District Hospital NHS Foundation Trust
Yeovil District Hospital NHS Foundation Trust runs Yeovil District Hospital in Yeovil, Somerset, England. It provides acute care for a population of about 180,000, people living in South Somerset, North and West Dorset, and parts of Mendip. The ...
;
Royal Wolverhampton NHS Trust
The Royal Wolverhampton NHS Trust (formerly Royal Wolverhampton Hospitals NHS Trust) runs New Cross Hospital and West Park Rehabilitation Hospital in Wolverhampton and Cannock Chase Hospital in Cannock.
In December 2020 it agreed to appoint a jo ...
; and
Southern Health NHS Foundation Trust
Southern Health NHS Foundation Trust is an NHS foundation trust which provides community health, mental health and learning disability services across Hampshire. It is one of the largest providers of such services in England.
History
The trus ...
have taken over multiple GP practices in the interests of integration.
GP Federations have become popular among English
general practitioners.
Consultations
According to the
Local Government Association
The Local Government Association (LGA) is the national membership body for local authorities. Its core membership is made up of 339 English councils and the 22 Welsh councils through the Welsh Local Government Association.
The LGA is p ...
57 million GP consultations in England in 2015 were for minor conditions and illnesses, 5.2 million of them for blocked noses. According to the
King's Fund
The King's Fund is an independent think tank, which is involved with work relating to the health system in England. It organises conferences and other events.
Since 1997, they have jointly funded a yearly award system with GlaxoSmithKline. Th ...
between 2014 and 2017 the number of telephone and face-to-face contacts between patients and GPs rose by 7.5% although GP numbers have stagnated. The mean consultation length in the UK has increased steadily over time from around 5 minutes in the 1950s to around 9·22 minutes in 2013–2014.
This is shorter than the mean consultation length in a number of other developed countries around the world.
The proportion of patients in England waiting longer than seven days to see a GP rose from 12.8% in 2012 to 20% in 2017. There were 307 million GP appointments, about a million each working day, with more on Mondays, in the year from November 2017. 40% got a same-day appointment. 2.8 million patients, 10.3%, in October 2018, compared to 9.4% in November 2017, did not see the doctor until at least 21 days after they had booked their appointment, and 1.4 million waited for more than 28 days. More than a million people each month failed to turn up for their appointment.
Commercial providers are rare in the UK but a private GP service was established at Poole Road Medical Centre in Bournemouth in 2017 where patients can pay to skip waiting lists to see a doctor.
GP at Hand, an online service using
Babylon Health
Babylon Health is a digital-first health service provider that combines an artificial intelligence powered platform with virtual clinical operations for patients. Patients are connected with health care professionals through its web and mobile ...
's app, was launched in November 2017 by the Lillie Road Health Centre, a conventional GP practice in west London. It recruited 7000 new patients in its first month, of which 89.6% were between 20 and 45 years old. The service was widely criticized by GPs for cherry picking. Patients with long term medical conditions or who might need home visits were actively discouraged from joining the service.
Richard Vautrey
Richard Vautrey is a doctor who was Chair of the British Medical Association's (BMA) General Practitioners Committee. He is a nationally elected member of the BMA Council. He works as a general practitioner (GP) in Leeds and he is an assistant m ...
warned that it risked 'undermining the quality and continuity of care and further fragmenting the service provided to the public'.
The
COVID-19 pandemic in the United Kingdom
The COVID-19 pandemic in the United Kingdom is a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the United Kingdom, it has resulted in confir ...
led to a sudden move to remote working. In March 2020 the proportion of telephone appointments increased by over 600%.
Patient satisfaction
85% of patients rate their overall experience of primary care as good in 2016, but practices run by limited companies operating on APMS contracts (a small minority) performed worse on four out of five key indicators - frequency of consulting a preferred doctor, ability to get a convenient appointment, rating of doctor communication skills, ease of contacting the practice by telephone and overall experience.
Northern Ireland
There have been particularly acute problems in general practice in Northern Ireland as it has proved very difficult to recruit doctors in rural practices. The
British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
collected undated resignation letters in 2017 from GPs who threatened to leave the NHS and charge consultation fees. They demanded increased funding, more recruitment and improved computer systems.
A new GP contract was announced in June 2018 by the Northern Ireland Department of Health. It included funding for practice-based pharmacists, an extra £1 million for increased indemnity costs, £1.8 million because of population growth, and £1.5 million for premises upgrades.
Ireland
In Ireland there are about 2,500 General Practitioners working in group practices, primary care centres, single practices and health centres.
Australia
General Practice services in Australia are funded under the Medicare Benefits Scheme (MBS) which is a public health insurance scheme. Australians need a referral from the GP to be able to access specialist care. Most general practitioners work in a general practitioner practice (GPP) with other GPs supported by practice nurses and administrative staff. There is a move to incorporate other health professionals such as pharmacists in to general practice to provide an integrated multidisciplinary healthcare team to deliver primary care.
India
Family medicine (FM) came to be recognized as a
medical specialty
A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), ...
in India only in the late 1990s. According to the National Health Policy – 2002, there is an acute shortage of specialists in family medicine. As family physicians play a very important role in providing affordable and universal health care to people, the Government of India is now promoting the practice of family medicine by introducing post-graduate training through DNB (Diplomate National Board) programs.
There is a severe shortage of postgraduate training seats, causing a lot of struggle, hardship and a career bottleneck for newly qualified doctors just passing out of medical school. The Family Medicine Training seats should ideally fill this gap and allow more doctors to pursue family medicine careers. However, the uptake, awareness and development of this specialty is slow.
Although family medicine is sometimes called
general practice
General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be describe ...
, they are not identical in India. A medical graduate who has successfully completed the
Bachelor of Medicine, Bachelor of Surgery
Bachelor of Medicine, Bachelor of Surgery ( la, Medicinae Baccalaureus, Baccalaureus Chirurgiae; abbreviated most commonly MBBS), is the primary medical degree awarded by medical schools in countries that follow the tradition of the United King ...
(MBBS), course and has been registered with Indian Medical Council or any state medical council is considered a
general practitioner. A family physician, however, is a
primary care physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...
who has completed specialist training in the discipline of family medicine.
The
Medical Council of India
The Medical Council of India (MCI) was a statutory body for establishing uniform and high standards of medical education in India until its dissolution on 25 September 2020 when it was replaced by National Medical Commission. The Council grante ...
requires three-year residency for family medicine specialty, leading to the award of
Doctor of Medicine
Doctor of Medicine (abbreviated M.D., from the Latin language, Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a profes ...
(MD) in Family Medicine or
Diplomate of National Board
Diplomate of National Board (DNB) is a Post-graduate Master's degree same as MD/MS degree awarded to the Specialist Doctors in India after completion of three year residency. DNB courses are run and the degrees are awarded by the National Board of ...
(DNB) in Family Medicine.
The
National Board of Examinations
National Board of Examinations (NBE) is an autonomous body under the Ministry of Health and Family Welfare (India), Government of India, and established in 1975 at New Delhi as a Society under Delhi Society registration act, to standardizing pos ...
conducts family medicine residency programmes at the teaching hospitals that it accredits. On successful completion of a three-year residency, candidates are awarded Diplomate of National Board (Family Medicine). The curriculum of DNB (FM) comprises: (1) medicine and allied sciences; (2) surgery and allied sciences; (3) maternal and child health; (4) basic sciences and community health. During their three-year residency, candidates receive integrated inpatient and outpatient learning. They also receive field training at community health centres and clinics.
The Medical Council of India permits accredited medical colleges (medical schools) to conduct a similar residency programme in family medicine. On successful completion of three-year residency, candidates are awarded Doctor of Medicine (Family Medicine). A few of the AIIMS institutes have also started a course called MD in community and family medicine in recent years. Even though there is an acute shortage of qualified family physicians in India, further progress has been slow.
The
Indian Medical Association
The Indian Medical Association (IMA) is a national voluntary organisation of physicians in India. It was established in 1928 as the All India Medical Association, and was renamed the Indian Medical Association in 1930. It is a society registered ...
’s College of General Practitioners, offers a one-year Diploma in Family Medicine (DFM), a distance education programme of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, for doctors with minimum five years of experience in
general practice
General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be describe ...
. Since the Medical Council of India requires three-year residency for family medicine specialty, these diplomas are not recognized qualifications in India.
As India's need for primary and secondary levels of health care is enormous, medical educators have called for systemic changes to include family medicine in the undergraduate medical curriculum.
Recently, the residency-trained family physicians have formed the
Academy of Family Physicians of India (AFPI). AFPI is the academic association of family physicians with formal full-time residency training (DNB Family Medicine) in Family medicine. Currently there are about two hundred family medicine residency training sites accredited by the National Board of Examination India, providing around 700 training posts annually. However, there are various issues like academic acceptance, accreditation, curriculum development, uniform training standards, faculty development, research in primary care, ''etc.'' in need of urgent attention for family medicine to flourish as an academic specialty in India. The government of India has declared Family Medicine as focus area of human resource development in health sector in the National Health Policy 2002 There is discussion ongoing to employ multi-skilled doctors with DNB family medicine qualification against specialist posts in NRHM (National Rural Health Mission).
Three possible models of how family physicians will practise their specialty in India might evolve, namely (1) private practice, (2) practising at primary care clinics/hospitals, (3) practising as consultants at secondary/tertiary care hospitals.
British model
A group of 15 doctors based in Birmingham have set up a
social enterprise
A social enterprise is an organization that applies commercial strategies to maximize improvements in financial, social and environmental well-being. This may include maximizing social impact alongside profits for co-owners.
Social enterprises ca ...
company - Pathfinder Healthcare - which plans to build eight primary health centres in India on the British model of general practice. According to Dr Niti Pall, primary health care is very poorly developed in India. These centres will be run commercially. Patients will be charged ₹200 to 300 for an initial consultation, and prescribed only
generic drug
A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active ch ...
s, dispensed from attached pharmacies.
Japan
Family medicine was first recognized as specialty in 2015 and currently has approximately 500 certified family doctors.
The Japanese government has made a commitment to increase the number of family doctors in an effort to improve the cost-effectiveness and quality of primary care in light of increasing health care costs.
The Japan Primary Care Association (JPCA) is currently the largest academic association of family doctors in Japan. The JPCA family medicine training scheme consists of a three-year programme following the two-year internship.
The Japanese Medical Specialty Board define the standard of the specialty training programme for board-certified family doctors. Japan has a free access healthcare system meaning patients can bypass primary care services. In addition to family medicine specialists Japan also has ~100,000 organ-specialist primary care clinics.
The doctors working in these clinics do not typically have formal training in family medicine. In 2012, the mean consultation length in a family medicine clinic was 10.2 minutes.
A review literature has recently been published detailing the context, structure, process, and outcome of family medicine in Japan.
See also
*
ATC codes – Anatomical Therapeutic Chemical Classification System
*
Classification of Pharmaco-Therapeutic Referrals
The ''Classification of Pharmaco-Therapeutic Referrals'' (''CPR'') is a taxonomy focused on defining and grouping together situations requiring a referral from pharmacists to physicians (and vice versa) regarding the pharmacotherapy used by the ...
*
General practice
General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be describe ...
*
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
– International Classification of Diseases
*
ICPC-2 PLUS ICPC-2 PLUS is an extended terminology classified to ICPC-2 International Classification of Primary Care, which aids data entry, retrieval and analysis. ICPC-2 PLUS takes into account the frequency distribution of problems seen in primary health car ...
*
International Classification of Primary Care
The International Classification of Primary Care (ICPC) is a classification method for primary care encounters. It allows for the classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, primary or general heal ...
ICPC-2
*
Primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
*
Referral (medicine) In medicine, referral is the transfer of care for a patient from one clinician or clinic to another by request.
Tertiary care is usually done by referral from primary or secondary medical care personnel.
In the field of sexually transmitted dise ...
*
Walk-in clinic
A walk-in clinic (also known as a walk-in centre) is a medical facility that accepts patients on a walk-in basis and with no appointment required. A number of healthcare service providers fall under the walk-in clinic umbrella including urgent ...
Notes
References
Further reading
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{{DEFAULTSORT:Family Medicine
Family medicine in the United States
National Health Service