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Perceptual capacity and the good GP: invisible, yet indispensable for quality of care.

In his UK survey in 1950,1 Collings said that general practice, ‘is accepted as being something specific, without anyone knowing what it really is.’ One might have hoped that over 50 years later, we would be clearer about the specifics of what general practice is or is not. However, this is not the case. Much activity in general practice is dictated by the new General Medical services (GMS) contract.2 At the heart of this is a Quality and Outcomes Framework centred on population targets and founded on evidence-based medicine. This provides financial incentives to raise standards of care for the practice population. However, it has been criticised for being poorly attuned to the needs of the individual, and for concentrating on the disease, not the patient.3,4 There is also a growing focus on the importance of the narrative in general practice,5 which focuses on the individual patient rather than the disease.

It is therefore not surprising that many GPs now find it difficult to understand what a GP is meant to do, or indeed to be. In this paper we suggest that it is only through an approach which focuses on the perceptual capacity of the GP that we can adequately make good decisions with, or for, individual patients (Box 1). It follows that the development of this capacity should also be an important focus for GP training. This approach is an example of the development of virtue ethics in the field of professional roles over the past few years.6,7

### Box 1. Some definitions