Holism in primary care: the views of Scotland's general practitioners

Abstract

A holistic approach to care has traditionally been the central tenet of general practice in the UK. However, recent major changes in general practice may be diminishing the importance and/or deliverability of such an approach. We sought to explore the views of Scotland’s general practitioner (GP) principals. We surveyed all 3713 GP principals in Scotland during February to July 2001 by postal questionnaire. Nearly 9 in 10 GPs (87%) felt that a holistic approach was essential to providing good health care, but only 1 in 5 (21%) felt that primary care was currently delivering high-quality holistic care, and only 1 in 15 (7%) felt that the current organization of primary care was conducive to such care. Constraints on holism were thought to contribute significantly to higher rates of prescribing (73% agreed), more referrals to secondary care (63% agreed), and increased demand for complementary therapies (57% agreed). Psychological factors were considered to play an important role in organic physical disease – its causation (67% agreed), course (94% agreed) and reversal (69% agreed) – yet when either the GP or the patient wished to explore issues relating to stress or emotional difficulties the GPs felt significantly constrained, mainly by time and their own stress (mean values (95% CI); 0: not limiting, 10: extremely limiting; time 7.6 (7.49–7.67); stress 4.9 (4.84–5.04); training 4.7 (4.66–4.84); skills 4.2 (4.13–4.30); motivation 3.4 (3.33–3.50)). In this survey Scotland’s principal GPs overwhelmingly endorse the traditional holistic approach of general practice and primary care, but feel that it is failing to be delivered due to organizational and time constraints, with consequent human and financial costs. These results give voice to deep concerns among GPs who remain committed to a holism they are struggling to deliver.