Opportunities and risks within the expanding role of general practice

General practice has been increasingly required to expand its role to take on more complex care -demands enabled by the fluid boundaries of what constitutes 'general practice'.To date, this expansion has largely related to the care of older patients with multiple morbidities; however, medical advances also present increasing opportunities to relocate specific treatments to primary care that have previously been the sole domain of hospital specialists.With the pressures of COVID-19 and yet more proposed NHS reorganisation, is it fair, or even feasible, to expect GPs to take on more responsibility, which may also open them to censure or legal liability? CHANGING ROLE OF GENERAL PRACTICEThe parameters of 'general practice' shift frequently in response to the exigencies of politics, economics, demographics and changing health needs.Descriptions of the GP role are often imprecise, using language such as 'expert generalist' and referring to abstract values such as 'competency'. 1he 2018 Scottish General Medical Services Contract is based on the four principles of 'contact, comprehensiveness, continuity and co-ordination' 2 and the English GP contract requires the provision of 'services' in broad areas such as 'chronic disease', 3 but neither is specific to conditions or treatments.This lack of precision may be inevitable for a profession with the title 'general practitioner', but while it is difficult, and perhaps unwise, to be prescriptive about every aspect of the role, this leaves general practice more vulnerable than most medical specialties to reorganisation.GPs work increasingly with allied health professionals as well as leading teams of support staff whose roles are similarly being expanded.This presents both opportunities and risks in terms of team-working skills and coordination of care, as well as questions over who should bear ultimate decision-making responsibility for complex cases.Over the years, NHS policy and GP contracts in each of the UK nations have demonstrated continual restructuring and extension of the boundaries of GP care to take on additional services, moving increasingly complex care into the community. 2,4The means of delivering such care are also shifting, with digital technologies expanding modes of consultation; ongoing technological advances making remote monitoring possible for many chronic conditions; and GPs embedded more