There are differing views on whether generalists or specialists provide better quality, cost-effective care. The trend has been to increase specialisation and the number of specialties and subspecialties. The drawback of a highly specialised workforce is that it is less flexible or adaptable to respond to the pace of change at an individual and collective level.

Some have argued that 'generalism at the right places along the pathway can save money by having just one person treat a patient instead of sending them to several different consultants' and that ‘there is the potential for a rationalisation of the specialties such as Denmark has done.’

Proposed workforce impact

• The ratio of GP generalists to specialists is impacted.
• The number of specialties changes.
• The role of a GP is redefined from gatekeeper to care navigator, shifting from individual care to thinking and being influential for the population’s health.
• There is a rebalancing of medical training posts to a possible 50:50 generalist / non-generalist split.
• GPs have to provide more community-based diagnostics and therefore obtain the skills to provide this service.

Sources or references

• Tooke Report - Aspiring to Excellence: Final Report of the Independent Inquiry into Modernising Medical Careers; http://www.mmcinquiry.org.uk/draft.htm
• Lambert, Trevor; Goldacre, Michael Source: British Journal of General Practice, Volume 61, Number 588, July2011 , pp. e397-e403(7)
• Medical graduates’ early career choices of specialty and their eventual specialty destinations; http://www.bmj.com//node/382174?variant=abstract
• http://www.rcgp.org.uk/pdf/AC2011%20-%20A2.pdf
• http://www.shapeoftraining.co.uk/aboutus/1727.asp

Additional research questions

• Is the rebalancing of medical training posts to a possible 50:50 generalist/non-generalist split correct?

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.