Editing General practitioner (section)

== Europe ==

=== European Union ===
General practitioners are regulated in the EU by [[Directive 2005/36/EC]].<ref name="Directive 2005/36/EC">[http://data.europa.eu/eli/dir/2005/36/oj Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications, Official Journal of the European Union, 30.9.2005]</ref>

==== France ====
In France the '''''médecin généraliste''''' (commonly called ''médecin de famille'') is responsible for primary care medicine, including non-vital emergencies and patient's follow up.<ref>{{cite web |url=http://www.onisep.fr/Ressources/Univers-Metier/Metiers/medecin-generaliste |title=Accueil: Secteurs: Fiches métier: médecin généraliste |publisher=National Office for Information on Education and Occupations (ONISEP) |website=www.onisep.fr |access-date=4 November 2016 |url-status=live |archive-url=https://web.archive.org/web/20161105032735/http://www.onisep.fr/Ressources/Univers-Metier/Metiers/medecin-generaliste |archive-date=5 November 2016 }}</ref> This implies prevention, education, care of the [[disease]]s and [[Physical trauma|trauma]]s.  The general practitionner orientates the patients to other specialists when necessary. 

They have a role in the survey of [[epidemy|epidemics]], a legal role (constatation of traumas that can bring compensation, certificates for the practice of a [[sport]], [[death certificate]], certificate for hospitalisation without consent in case of mental incapacity), and a role in the [[emergency medicine|emergency care]] (they can be called by the ''samu'', the French [[emergency medical service|EMS]]). They often go to a patient's home when the patient cannot come to the consulting room (especially in case of children or old people), and have to contribute to night and week-end duties. {{citation needed|date=August 2012}}

The studies consist of six years at university (common to all medical specialities), and four years as a resident (''interne'')&nbsp;:
* the first year (PASS, ''Parcours d'Accès Spécifique Santé'', often abbreviated to ''P1'' by students) is common with the dentists, pharmacists and [[midwives]]. The rank at the final competitive examination<ref>Marchand-Antonin, Benoît. "[http://thesesdemedecine.free.fr/wp-content/thesis/NumerusClausus.BenoitMarchandAntonin.pdf The ''numerus clausus'' : its side effects - its place in globalization of the medicine] {{webarchive|url=https://web.archive.org/web/20110720230935/http://thesesdemedecine.free.fr/wp-content/thesis/NumerusClausus.BenoitMarchandAntonin.pdf |date=2011-07-20 }}"</ref> determines in which branch the student can choose to study.
* the following two years, called ''propédeutique'', are dedicated to the fundamental sciences: [[anatomy]], human [[physiology]], [[biochemistry]], [[bacteriology]], [[statistics]]...
* the three following years are called ''externat'' and are dedicated to the study of [[clinical medicine]]; they end with a classifying examination, the rank determines in which specialty (general medicine is one of them) the student can make her or his ''internat'';
* the ''internat'' is three years -or more depending on the specialty- of initial professional experience under the responsibility of a ''senior''; the ''interne'' can prescribe, s/he can replace physicians,<ref>Guedes-Marchand, Cécile. "[http://thesesdemedecine.free.fr/wp-content/thesis/RemplacantMedGen.CecileGuedesMarchand.pdf Le remplaçant, cet intermittent de la médecine générale : sa place dans le système de soins] {{webarchive|url=https://web.archive.org/web/20110720231207/http://thesesdemedecine.free.fr/wp-content/thesis/RemplacantMedGen.CecileGuedesMarchand.pdf|date=2011-07-20}}"</ref> and usually works in a hospital.
This ends with a [[doctorate]], a research work which usually consist of a statistical study of cases to propose a care strategy for a specific condition (in an epidemiological, diagnostic, or therapeutic point of view).

==== Greece ====
General Practice was established as a medical specialty in Greece in 1986. To qualify as a General Practitioner (γενικός ιατρός, genikos iatros) doctors in Greece are required to complete four years of vocational training after medical school, including three years and two months in a hospital setting.<ref>{{cite web |title= Primary Care in Greece |url= http://www.euprimarycare.org/column/primary-care-greece |publisher= European Forum for Primary Care |url-status= dead |archive-url= https://web.archive.org/web/20140201213157/http://www.euprimarycare.org/column/primary-care-greece |archive-date= 2014-02-01 |access-date= 2013-11-18 }}</ref> General Practitioners in Greece may either work as private specialists or for the National Healthcare Service, ESY (Εθνικό Σύστημα Υγείας, ΕΣΥ).

==== Netherlands and Belgium ====
General practice in the Netherlands and Belgium is considered advanced. The ''huisarts'' (literally: "home doctor") administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in [[palliative care]].

In Belgium, one year of lectures and two years of [[residency (medicine)|residency]] are required. In the Netherlands, training consists of three years (full-time) of specialization after completion of internships of 3 years.<ref>{{cite web|url=http://www.uemo.eu/gp-in-europe/83-the-netherlands.html|title=GP in Europe: The Netherlands|publisher=UEMO|access-date=31 May 2014|url-status=dead|archive-url=https://web.archive.org/web/20140531125001/http://www.uemo.eu/gp-in-europe/83-the-netherlands.html|archive-date=31 May 2014}}</ref> First and third year of training takes place at a GP practice. The second year of training consists of six months training at an emergency room, or internal medicine, paediatrics or gynaecology, or a combination of a general or academic hospital, three months of training at a psychiatric hospital or outpatient clinic and three months at a nursing home (verpleeghuis) or clinical geriatrics ward/policlinic. During all three years, residents get one day of training at university while working in practice the other days. The first year, a lot of emphasis is placed on communications skills with video training. Furthermore, all aspects of working as a GP gets addressed including working with the medical standards from the Dutch GP association NHG (Nederlands Huisartsen Genootschap).<ref>{{cite web|url=http://nhg.artsennet.nl/kenniscentrum/k_richtlijnen/k_nhgstandaarden.htm |title=NHG-Standaarden |publisher=Nhg.artsennet.nl |date=2012-10-18 |access-date=2012-10-28 |url-status=dead |archive-url=https://web.archive.org/web/20130116222730/http://nhg.artsennet.nl/kenniscentrum/k_richtlijnen/k_nhgstandaarden.htm |archive-date=2013-01-16 }}</ref>
All residents must also take the national GP knowledge test (Landelijke Huisartsgeneeskundige Kennistoets (LHK-toets)) twice a year.<ref name="huisartsopleiding.nl">{{cite web|url=http://huisartsopleiding.nl/content.asp?kid=10072029&bid=10028521 |title=Huisartsopleiding Nederland - LHK-toets |publisher=Huisartsopleiding.nl |access-date=2012-10-28 |url-status=dead |archive-url=https://web.archive.org/web/20130521130104/http://huisartsopleiding.nl/content.asp?kid=10072029&bid=10028521 |archive-date=2013-05-21 }}</ref> In this test of 120 multiple choice questions, medical, ethical, scientific and legal matters of GP work are addressed.<ref name="huisartsopleiding.nl"/><ref>{{cite web|url=http://knmg.artsennet.nl/Opleiding-en-Registratie/opleiding/hvrc.htm |archive-url=https://archive.today/20120710164147/http://knmg.artsennet.nl/Opleiding-en-Registratie/opleiding/hvrc.htm |url-status=dead |archive-date=2012-07-10 |title=Opleiding tot huisarts |publisher=Knmg.artsennet.nl |access-date=2012-10-28 }}</ref>

==== Spain ====
[[File:DivinoValles.jpg|thumb|200px| [[Francisco Vallés]] (Divino Vallés)]]

In Spain GPs are officially '''especialistas en medicina familiar y comunitaria''' but are commonly called "''médico de cabecera''" or "''médico de familia''".<ref>[[:es:Medicina familiar y comunitaria]]{{Circular reference|date=May 2022}}</ref> It was established as a medical specialty in Spain  in 1978.<ref>{{cite web | url=https://www.boe.es/buscar/doc.php?id=BOE-A-1979-3116 | title=Real Decreto 3303/1978, de 29 de diciembre, de regulación de la medicina de familia y comunitaria como especialidad de la profesión médica | pages=2735–2736 }}</ref>

Most Spanish GPs work for the state-funded health services provided by the county's 17 regional governments (''comunidades autónomas''). They are in most cases salary-based healthcare workers.

For the provision of primary care, Spain is currently divided geographically in basic health care areas (''áreas básicas de salud''), each one containing a primary health care team (''Equipo de atención primaria''). Each team is multidisciplinary and typically includes GPs, community pediatricians, nurses, physiotherapists and social workers, together with ancillary staff. In urban areas all the services are concentrated in a single large building (Centro de salud) while in rural areas the main center is supported by smaller branches (''consultorios''), typically single-handled.<ref>{{cite web|url=http://www.msc.es/ciudadanos/prestaciones/centrosServiciosSNS/hospitales/introduccionCentro.htm|title=Ministerio de Sanidad, Servicios Sociales e Igualdad - Ciudadanos - Ministerio de Sanidad y Consumo - Ciudadanos - Sistema Nacional de Salud - Centros|website=www.msc.es|url-status=live|archive-url=https://web.archive.org/web/20100109111313/http://www.msc.es/ciudadanos/prestaciones/centrosServiciosSNS/hospitales/introduccionCentro.htm|archive-date=2010-01-09}}</ref>

Becoming a GP in Spain involves studying medicine for 6 years, passing a competitive national exam called MIR (''Medico Interno Residente'') and undergoing a 4-year training program. The training program includes core specialties as general medicine and general practice (around 12 months each), pediatrics, gynecology, orthopedics and psychiatry. Shorter and optional placements in ENT, ophthalmology, ED, infectious diseases, rheumathology or others add up to the 4 years curriculum. The assessment is work based and involves completing a logbook that ensures all the expected skills, abilities and aptitudes have been acquired by the end of the training period.<ref>{{cite web |url=http://www.msc.es/profesionales/formacion/docs/medifamiliar.pdf |title=Ministerio de Sanidad |access-date=2013-03-07 |url-status=live |archive-url=https://web.archive.org/web/20130513091914/http://www.msc.es/profesionales/formacion/docs/medifamiliar.pdf |archive-date=2013-05-13 }}</ref><ref>[[:es:Examen MIR]]{{Circular reference|date=May 2022}}</ref>

===Russia===
In the Russian Federation, the General Practitioner's Regulation was put into effect in 1992, after which medical schools started training in the relevant specialty.
The right to practice as a general practitioner gives a certificate of appropriate qualifications. General medical practice can be carried out both individually and in a group, including with the participation of narrow specialists. The work of general practitioners is allowed, both in the medical institution and in private.
The general practitioner has broad legal rights. He can lead junior medical personnel, provide services under medical insurance contracts, conclude additional contracts to the main contract, and conduct an examination of the quality of medical services. For independent decisions, the general practitioner is responsible in accordance with the law.

The main tasks of a general practitioner are:
*Prevention, diagnosis and treatment of the most common diseases;
*Emergency and emergency medical care;
*Performance of medical manipulations.

=== United Kingdom ===
{{See also|General practice}}
In the United Kingdom physicians wishing to become GPs take at least five years' training after [[Medical school (United Kingdom)|medical school]], which is usually an undergraduate course of five to six years (or a graduate course of four to six years) leading to the degrees of [[Bachelor of Medicine and Surgery|Bachelor of Medicine and Bachelor of Surgery]].

Until 2005, those wishing to become a general practitioner of medicine had to do a minimum of the following postgraduate training:
* One year as a [[pre-registration house officer]] (PRHO) (formerly called a house officer), in which the trainee would usually spend six months on a general surgical ward and six months on a general medical ward in a hospital;
* Two years as a [[senior house officer]] (SHO) – often on a General Practice Vocational Training Scheme (GP-VTS) in which the trainee would normally complete four six-month jobs in hospital specialties such as obstetrics and gynaecology, paediatrics, geriatric medicine, accident and emergency or psychiatry;
* One year as a general practice registrar on a GPST.

This process changed under the programme [[Modernising Medical Careers]]. Medical practitioners graduating from 2005 onwards have to do a minimum of five years postgraduate training:
* Two years of ''Foundation Training'', in which the trainee will do a rotation around either six four-month jobs or eight three-month jobs – these include at least three months in general medicine and three months in general surgery, but will also include jobs in other areas;
*  A three-year "run-through" GP Speciality Training Programme containing (GPSTP): This comprises a minimum of twelve months as a hospital based Specialty Trainee during which time the trainee completes a mixture of jobs in specialties such as [[obstetrics]] and [[gynaecology]], [[paediatrics]], [[geriatric medicine]], [[Emergency department|accident and emergency]] or [[psychiatry]]; eighteen to twenty-four months as a GP Specialty Trainee working in General Practice.<ref>{{Cite web|title=CCT|url=https://www.rcgp.org.uk/training-exams/discover-general-practice/qualifying-as-a-gp-in-the-nhs/certificate-of-completion-of-training-cct-guidance-for-gp-trainees.aspx|access-date=2021-12-29|website=www.rcgp.org.uk}}</ref> The balance of training time spent in hospital versus in GP is planned to shift in 2022 to be consistently 12 months' hospital training and 24 months' training time in general practice.<ref>{{Cite web|date=2020-02-07|title=GP trainees to spend longer training in general practice under new contract|url=https://www.pulsetoday.co.uk/news/uncategorised/gp-trainees-to-spend-longer-training-in-general-practice-under-new-contract/|access-date=2021-12-29|website=Pulse Today|language=en}}</ref>
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The postgraduate qualification [[Membership of the Royal College of General Practitioners]] (MRCGP) was previously optional. In 2008, a requirement was introduced for physicians to succeed in the MRCGP assessments in order to be issued with a certificate of completion of their specialty training (CCT) in general practice. After passing the assessments, they are eligible to use the [[post-nominal letters]] MRCGP (so long as the physicians continued to pay membership fees to the RCGP, though many do not). During the GP specialty training programme, the medical practitioner must complete a variety of assessments in order to be allowed to practice independently as a GP. There is a knowledge-based exam with multiple choice questions called the Applied Knowledge Test (AKT). The practical examination takes the form of a "simulated surgery" in which the physicians is presented with thirteen clinical cases and assessment is made of data gathering, interpersonal skills and clinical management. This Clinical Skills Assessment (CSA) is held on three or four occasions throughout the year and takes place at the renovated headquarters of the [[Royal College of General Practitioners]] (RCGP), at [[30 Euston Square]], [[London]]. Finally, throughout the year the physician must complete an electronic portfolio which is made up of case-based discussions, critique of videoed consultations and reflective entries into a "learning log".

In addition, many hold qualifications such as the DCH (Diploma in Child Health of the [[Royal College of Paediatrics and Child Health]]) or the DRCOG (Diploma of the [[Royal College of Obstetricians and Gynaecologists]]), the DPD (Diploma in Practical Dermatology) or the DGH (Diploma in Geriatric Medicine of the Royal College of Physicians). Some General Practitioners also hold the MRCP (Member of the [[Royal College of Physicians]]) or other specialist qualifications, but generally only if they had a hospital career, or a career in another speciality, before training in General Practice.

There are many arrangements under which general practitioners can work in the UK. While the main career aim is becoming a principal or partner in a GP surgery, many become salaried or non-principal GPs, work in hospitals in GP-led acute care units or perform locum work. Whichever of these roles they fill, the vast majority of GPs receive most of their income from the [[National Health Service]] (NHS). Principals and partners in GP surgeries are self-employed, but they have contractual arrangements with the NHS which give them considerable predictability of income.

[[Image:Jericho Health Centre 20050326.jpg|thumb|left|GPs in the United Kingdom may operate in community health centres.]]Visits to GP surgeries are free in all countries of the United Kingdom, but charges for prescriptions are applied in England (except for those over 60, under 18, and those on low incomes and welfare). Wales, Scotland and Northern Ireland have abolished all charges.<ref>{{Cite news|url=https://www.bbc.com/news/uk-12928485|title=Scots prescription fees abolished|date=2011-04-01|access-date=2019-08-15|language=en-GB}}</ref>

Recent reforms to the NHS have included changes to the [[General medical services|GP contract]]. General practitioners are no longer required to work unsociable hours and get paid to some extent according to their [[Pay for performance (healthcare)|performance]], (e.g. numbers of patients treated, what treatments were administered, and the health of their catchment area, through the [[Quality and Outcomes Framework]]). The IT system used for assessing their income based on these criteria is called [[Quality Management and Analysis System|QMAS]]. The amount that a GP can expect to earn does vary according to the location of their work and the health needs of the population that they serve. Within a couple of years of the new contract being introduced, it became apparent that there were a few examples where the arrangements were out step with what had been expected.<ref>{{cite news |url=http://observer.guardian.co.uk/uk_news/story/0,,1759412,00.html |title=Perks of an island GP: seals, scenery and £300,000 |publisher=The Observer |author=Jo Revill |access-date=2008-06-17 |date=2006-04-23 |location=London |url-status=live |archive-url=https://web.archive.org/web/20080102130550/http://observer.guardian.co.uk/uk_news/story/0,,1759412,00.html |archive-date=2008-01-02 }}</ref> A full-time self-employed GP, such as a GMS or PMS practice partner, might currently expect to earn a profit share of around £95,900 before tax<ref>{{cite web|url=http://www.mysalary.co.uk/average-salary/Gp_1231|title=Gp Average Salary|website=www.mysalary.co.uk|url-status=live|archive-url=https://web.archive.org/web/20130331084926/http://www.mysalary.co.uk/average-salary/Gp_1231|archive-date=2013-03-31}}</ref> while a GP employed by a [[clinical commissioning group|CCG]] could expect to earn a salary in the range of £54,863 to £82,789.<ref>{{cite web |title=Pay for doctors |url=http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/ |publisher=NHS careers |access-date=2014-05-11 |url-status=live |archive-url=https://web.archive.org/web/20140512231540/http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/ |archive-date=2014-05-12 }}</ref> This can equate to an hourly rate of around £40 an hour for a GP partner.<ref>{{cite news |url=https://www.theguardian.com/g2/story/0,,1756277,00.html |title=The question: Is your GP worth £250,000? |work=The Guardian |access-date=2008-06-17 | location=London | first=Sarah | last=Boseley | date=2006-04-19}}</ref>

A survey by [[Ipsos MORI]] released in 2011 reports that 88% of adults in the UK "trust doctors to tell the truth".<ref name=IpsMor2011>{{cite web | url = http://www.ipsos-mori.com/researchpublications/researcharchive/2818/Doctors-are-most-trusted-profession-politicians-least-trusted.aspx | title = Doctors are most trusted profession – politicians least trusted Trust in Professions 2011 | access-date = 2011-07-03 | date = 2011-06-27 | publisher = [[Ipsos Mori]] | url-status = live | archive-url = https://web.archive.org/web/20110701203202/http://www.ipsos-mori.com/researchpublications/researcharchive/2818/doctors-are-most-trusted-profession-politicians-least-trusted.aspx | archive-date = 2011-07-01 }}</ref>

In May 2017, there was said to be a crisis in the UK with practices having difficulties recruiting GPs they need. [[Helen Stokes-Lampard]] of the Royal College of General Practitioners said, "At present, UK general practice does not have sufficient resources to deliver the care and services necessary to meet our patients' changing needs, meaning that GPs and our teams are working under intense pressures, which are simply unsustainable. Workload in general practice is escalating – it has increased 16% over the last seven years, according to the latest research – yet investment in our service has steadily declined over the last decade and the number of GPs has not risen in step with patient demand ... This must be addressed as a matter of urgency.".<ref>{{cite news|url=https://www.theguardian.com/society/2017/may/12/gp-recruitment-crisis-intensifies-as-vacancies-soar-to-122|title=GP recruitment crisis intensifies as vacancies soar to 12.2%|agency=Press Association|date=11 May 2017|url-status=live|archive-url=https://web.archive.org/web/20170512085935/https://www.theguardian.com/society/2017/may/12/gp-recruitment-crisis-intensifies-as-vacancies-soar-to-122|archive-date=12 May 2017|newspaper=The Guardian}}</ref> Professor [[Azeem Majeed]] from Imperial College has also raised concerns about general practice in the UK.

In 2018 the average GP worked less than three and a half days a week because of the "intensity of working day".<ref>{{cite news |title=GP hours and the much needed tech-care revolution |url=https://www.hsj.co.uk/gps/gp-hours-and-the-much-needed-tech-care-revolution/7023199.article |access-date=1 October 2018 |publisher=Health Service Journal |date=22 August 2018}}</ref>

There is an [[NHS England]] initiative to situate GPs in or near hospital emergency departments to divert minor cases away from A&E and reduce pressure on emergency services. 97 hospital trusts have been allocated money, mostly for premises alterations or development.<ref>{{cite news|title=Further £21m allocated for services set to move 200 GPs into hospitals|url=http://www.gponline.com/further-21m-allocated-services-set-move-200-gps-hospitals/article/1436698|access-date=14 July 2017|publisher=GP Online|date=16 June 2017|url-status=live|archive-url=https://web.archive.org/web/20170619130145/http://www.gponline.com/further-21m-allocated-services-set-move-200-gps-hospitals/article/1436698|archive-date=19 June 2017}}</ref>