for Joint Working Party of the Welsh Council of the Royal College of General Practitioners and the Welsh General Medical Services Committee

Correspondence and requests for full version of document to: Dr D H O Lloyd, Cadwgan Surgery, Old Colwyn, Clwyd LL29 9NP.

The following paper is an abridged version of a discussion document drawn up to generate debate about the clinical generalist of the future. In particular it aims to clarify the position of clinical generalists by defining their role, outlining their strength, demonstrating the central position of the patient, and considering future work patterns and relationships.

The role of general practitioners is being redefined in the light of the emphasis on more care in the community, economic factors, and patients' expectations. The strength of general practice lies in the doctor-patient relationship; this strength must not be lost sight of. Specific tasks of the general practitioner include the responsibility for the care of individuals; the role of gatekeeper; broad knowledge of curative, preventive, and rehabilitative medicine; teamwork; management; and development of population based strategies. Future work patterns include the general practitioner first and foremost as a clinician and an integrator of health services, but they also involve audit, education and training, research, management, and relations with organisations in the public, private, and voluntary sectors. It is important to make changes only when they benefit patients and to maintain the principle of equity of access to care.

General practitioners have occupied a central position in the provision of primary health care for many years and their role has evolved in response to professional, political, and social pressures. At the introduction of the NHS the average general practitioner was single handed, worked from home, often had no ancillary staff, but provided exceptional personal continuity of care. Now he or she works …