general practitioner general practitioner in the medical profession, a general practitioner (gp) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. gps' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. they are trained to treat patients to levels of complexity that vary between countries. the term "primary care physician" is more usually used in the us. in asian countries like india, this term has been replaced mainly by medical officers, registered medical practicioner etc. a core element in general practice is continuity that bridges episodes of various illnesses. greater continuity with a general practitioner has been shown to reduce the need for out-of-hours services and acute hospital admittance. continuous care by the same general practitioner has been found to reduce mortality. the role of a gp can vary greatly between (or even within) countries. in urban areas of developed countries, their roles tend to be narrower and focused on the care of chronic health problems; the treatment of acute non-life-threatening diseases; the early detection and referral to specialised care of patients with serious diseases; and preventive care including health education and immunisation. meanwhile, in rural areas of developed countries or in developing countries, a gp may be routinely involved in pre-hospital emergency care, the delivery of babies, community hospital care and performing low-complexity surgical procedures. in some healthcare systems gps work in primary care centers where they play a central role in the healthcare team, while in other cases gps work as sole practitioners. the term general practitioner or gp is common in the united kingdom, republic of ireland, australia, canada, singapore, south africa, new zealand and many other commonwealth countries. in these countries, the word "physician" is largely reserved for certain other types of medical specialists, notably in internal medicine. while in these countries, the term gp has a clearly defined meaning, in north america the term has become somewhat ambiguous, and is sometimes synonymous with the terms family doctor or primary care physician, as described below. historically, the role of a gp was once performed by any doctor with qualifications from a medical school working in the community. however, since the 1950s, general practice has become a specialty in its own right, with each country having specific training requirements. the 1978 alma ata declaration set the intellectual foundation of primary care and general practice. asia india and bangladesh the basic medical degree in india and bangladesh is mbbs (bachelor of medicine, bachelor of surgery). these generally consist of a four-and-a-half-year course followed by a year of compulsory rotatory internship in india. in bangladesh it is a five-year course followed by a year of compulsory rotatory internship. the internship requires the candidate to work in all departments for a stipulated period of time, to undergo hands-on training in treating patients. the registration of doctors is usually managed by state medical councils. a permanent registration as a registered medical practitioner is granted only after satisfactory completion of the compulsory internship. the federation of family physicians' associations of india (ffpai) is an organization which has a connection with more than 8000 general practitioners through having affiliated membership. pakistan in pakistan, 5 years of mbbs is followed by one year of internship in different specialties. pakistan medical and dental council (pmdc) then confers permanent registration, after which the candidate may choose to practice as a gp or opt for specialty training. the first family medicine training programme was approved by the college of physicians and surgeons of pakistan (cpsp) in 1992 and initiated in 1993 by the family medicine division of the department of community health sciences, aga khan university, pakistan. family medicine residency training programme of ziauddin university is approved for fellowship in family medicine. europe france in france the médecin généraliste (commonly called docteur) is responsible for the long-term care in a population. this implies prevention, education, care of the diseases and traumas that do not require a specialist, and orientation towards a specialist when necessary. they also follow the severe diseases day-to-day (between the acute crises that require the intervention of a specialist). they have a role in the survey of 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 care (they can be called by the samu, the french 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 a night and week-end duty (although this was contested in a strike in 2002). the studies consist of six years in the university (common to all medical specialties), and three years as a junior practitioner (interne) : the first year (paces, première année commune aux études de santé, often abbreviated to p1 by students) is common with the dentists, pharmacists and midwifery. the rank at the final competitive examination 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, 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. 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 are required. in the netherlands, training consists of three years (full-time) of specialization after completion of internships of 3 years. 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). all residents must also take the national gp knowledge test (landelijke huisartsgeneeskundige kennistoets (lhk-toets)) twice a year. in this test of 120 multiple choice questions, medical, ethical, scientific and legal matters of gp work are addressed. 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. spain 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". was established as a medical specialty in spain in 1978. 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. 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 years 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. united kingdom in the united kingdom physicians wishing to become gps take at least five years training after 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 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, accident and emergency or psychiatry; eighteen to twenty-four months as a gp specialty trainee working in general practice. 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. medical career grades of the national health service year current (modernising