Summary

The ethical aspects of everyday work in primary health care in the UK are discussed in this chapter. In this context, four main ethical concepts of beneficence, non-maleficence, autonomy and justice, described in Chapter Two, are reviewed within the context of primary health care. Issues such as the conflicting responsibilities for primary health professionals in their duty of care to an individual and to the greater community are discussed. The implications of evidence-based clinical care and the concept of clinical equipoise are considered, as well as issues of competence and consent. The uncertain and complex world of primary health care will be described as the setting for these issues and the allocation of restricted resources is reviewed. The need to take into account patients’ views, beliefs and values as well as implications for teaching and research in primary care are discussed. Future challenges including the implications of the 2006 White Paper, Our health, our care, our say, are also considered.

Introduction

While the ethical principles that underpin professional practice across the spectrum of health and social care work are largely consistent, the application of these principles has to reflect the particular context. Primary health care and the relationship that occurs between the patient or client and his or her professional attendants have some particular features.

In the UK and many other countries, general practice is the path by which people gain access to the range of health services to which they are entitled. While the degree to which a gatekeeping function is exercised varies, all general practitioners (GPs) have parallel obligations to individuals, communities and the state.

The key relationship between a professional and an individual may be nested within the relationship that the same professional has with other individual family members and the family as a whole. Additionally, GPs have knowledge of, and obligations to, the wider community; as a consequence the professional may have to balance competing considerations in the application of ethical principles.

The long-term or longitudinal relationship between a patient and professional, such as a family doctor, can foster the development of mutual trust, reinforced by shared experiences. Berger (1967) talks of the GP as the objective witness to the lives of patients or ‘clerk to the records’.

Within this relationship the GP accompanies people as they make sense of what is happening to themselves – their bodies and sometimes their minds too.