A career in general practice is a demanding one and the skills and attributes required are many and varied. GPs need to demonstrate empathy, compassion, and the ability to motivate others; they need to have good consultation skills, decision-making skills (what tests/examinations are required? Should the patient be referred?), analytical skills (what do those test results even mean?). All this on top of the considerable knowledge base that is required to manage the vast range of conditions encountered in primary care.

In September 2019, The Royal College of General Practitioners (RCGP), the British Medical Association (BMA) and the General Medical Council (GMC) issued a joint statement recognising that GPs are expert medical generalists, and as such are specialists in general practice. There are also plans to merge the separate GP and specialist registers held by the GMC.1

General practice is about taking a holistic view; considering the patient and all of their issues and illnesses and the interplay between them. This is becoming increasingly complex because of the growing number of patients with multiple co-existing conditions. Then there is the responsibility of managing patients who are often presenting at an earlier stage of disease, when the diagnosis may be less clear but also a time when the right interventions can have a greater impact on the patient’s health outcomes (and of course, NHS expenditure). Plus the added pressure of continuous vigilance so as to not overlook outwardly unremarkable symptoms or miss serious illness in seemingly ordinary presentations.

Healthcare professionals also have a duty of care to themselves, and staying well while keeping up with the demands of a busy job can be challenging. Given the current pressures on general practice it is not surprising that some GPs reach burnout and, understandably, this will have an impact on the care they can offer to their patients. Dr Honor Merriman describes how to identify the signs of burnout, highlights three core workplace needs that impact on the wellbeing of doctors, and provides practical steps for supporting colleagues and improving morale.

Given the broad range of health issues that patients present with, implementing guidance is an invaluable part of ensuring consistent, high-quality care. Our aim with Guidelines in Practice is to support you with managing your patients in line with guidance and best practice, through practical articles written by topic experts. This articles in this issue are described below.

The updated NICE guideline on fever in under 5s—Dr Nazia Hussain highlights new recommendations on Kawasaki disease and provides a recap on the other relevant elements of the guideline.

The updated BAP guideline on insomnia and sleep disorders—Professor Niroshan Siriwardena distils the most relevant recommendations for primary care covering assessment, screening for other conditions, treatment, and when to refer.

Personalising cancer care—Dr Anthony Cunliffe provides top tips on how to tailor care to individuals with cancer, including developing a personalised care plan, conducting a cancer care review, and recognising the physical effects of cancer and its treatment.

Personal life also has an impact on the lives of GPs: in this month’s View from the ground, Dr Toni Hazell talks about how being a doctor influences her role as a parent and, equally, how being a parent influences her role as a doctor. Dr Hazell considers how ‘Other doctors will have had experiences of chronic pain, disability, infertility, mental health problems, or having a child with a long-term illness—they will bring their own unique skills to every consultation.’ Is this you, and would you like to share your View from the ground? If so, please get in touch by emailing me at the address below.

So who will be the next patient to walk through the door? Will it be a feverish toddler brought in by a worried parent; a young adult experiencing perpetual sleepless nights; a patient in their 40s finding their feet after completing cancer treatment; or perhaps a GP-colleague struggling to cope with the many demands of their job? Read the articles in this issue to ensure you are prepared for such eventualities. 


1. General Medical Council, British Medical Association, Royal Colleage of General Practitioners. General practitioners: specialists in general practice. RCGP; 2019. www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2019/RCGP-joint-workforce-statement-2019.ashx?la=en