Proud to be expert generalists

In my GP26: Conference for general practice plenary, I wanted to remind the several hundred specialist GPs in the room of something that can sometimes get lost in conversations about access, targets and workforce pressures - and that we should be proud to say, clearly and confidently: we are expert generalists.

We are vocationally trained doctors who deliver complex, comprehensive, person-centred care over time, often in circumstances where nothing is pre-labelled, symptoms do not follow scripts, and clinical uncertainty must be managed safely.

Within minutes, we integrate physical health, mental health, family context and social reality. We carry decisions forward over years, revisit them, refine them, and live with their consequences. This is expert generalist work.

When conversations about our profession focus only on problems such as access, targets, workforce shortages and system pressure, instead of understanding the value of our comprehensive and complex care, the specialism of general practice can start to sound interchangeable with other parts of primary care. It is not.

The value of our role extends beyond individual consultations. The cradle-to-grave care we provide comes with managing uncertainty, holding risk, responding to increasing patient need, and providing clinical oversight for wider teams.

We understand this reality. Our challenge is ensuring the wider health system, policy makers and decision makers recognise and support it too.

Recognition that reflects expertise

Every role within the healthcare sector brings different skills and expertise to patient care. Understanding those differences is essential to building an effective workforce. For general practice, that means recognising the distinct role of vocational training and the responsibilities that come with it.

Primary care teams are already changing. Many specialist GPs are supervising, coordinating, supporting colleagues and holding clinical risk across teams that include nurses, nurse practitioners, pharmacists and allied health professionals. But too often this happens while GPs continue to carry unchanged caseloads of increasingly complex patients and, at times, clinical responsibility for patients seen by others.

That is not sustainable. Primary care teams must be properly designed so every professional has a clear role and scope of practice, care is coordinated, and responsibility is shared appropriately. That can only happen with clear clinical leadership. In general practice, that leadership must sit with vocationally trained GPs.

Recognition must also be reflected in the systems that fund and support care. Capitation should differentiate between vocationally trained GPs, non-vocationally trained GPs, registrars and other members of the general practice team. When a system understands the expertise required for a role, it is better equipped to design for it, resource it and sustain it.

Teaching and supervision are not optional extras

Every GP registrar has been shaped by specialist GPs who took the time to teach, mentor and supervise them. Yet teaching often happens alongside a full clinical workload, squeezed into already busy days.

The role of a specialist GP cannot be taught only from a university lecture room. Developing the future workforce requires more than goodwill and it requires protected time, appropriate funding, and recognition that teaching, supervision and clinical leadership are fundamental components of high-quality general practice.

Maintaining the highest standards of training

Like many professions, healthcare is constantly evolving, and vocational training must evolve with it. The upcoming curriculum review for GPEP years 2 and 3 is an opportunity to ensure training remains relevant to the realities of modern practice while maintaining the standards patients and communities rightly expect.

The GP working as a consultant and team leader in primary care requires deep generalist expertise, sound clinical judgement and the ability to support others safely within multidisciplinary care.

A strong voice in decisions that affect us

General practice is at the heart of healthcare. Yet too often, decisions about primary care are made without sufficient input from those delivering it every day. When specialist GPs have the time and support to participate in these discussions, policies are more likely to reflect the realities of community-based care, the needs of patients and whānau, and the complexity of services now being provided in general practice.

Continuing professional development is part of this. CPD is more than maintaining clinical knowledge. It creates opportunities for leadership, advocacy and engagement in the conversations shaping healthcare’s future. Specialist GPs need protected time and appropriate support to attend training, contribute to advisory groups, sit on taskforces and represent our profession.

If hospital-based specialist colleagues receive funded and protected time for these activities, it is reasonable to ask why specialist GPs do not. If other medical fields recognise completion of specialist training and Fellowship through remuneration, it is reasonable to ask why general practice remains treated differently.

The thread that connects it all

These priorities are connected by a common principle: general practice is built on relationships. Establishing continuity of care with our patients allows us to see the whole person, not just a single presentation or condition. It helps us make better, safer and more timely decisions. Our patients live healthier longer lives, they avoid hospitalisations and ED visits, and we save the health system money. Yet this foundation is under pressure from workforce pressures, increasing workloads and fragmentation of services.

As we continue to advocate for recognition, education, clinical leadership, professional development and sustainable funding, relational continuity must remain at the centre of the conversation. Because, as I said in my plenary, without relational continuity, there is no general practice.

This column was published on NZ Doctor on 11 September.