Guidance for medical staff reminds employees of the responsibility to deliver spiritual care in its broadest sense, respecting the dignity, humanity, individuality and diversity of the people whose cultures, faiths and beliefs coexist in society. This is no small or simple task, and although GPs (family practitioners) have been encouraged to deliver spiritual care, we suggest this is proving to be challenging and needs further careful debate. This literature review critiques and analyses existing studies and points to four categories of attitude to spiritual care, and two related but distinct concepts of spirituality in use by GPs. Our aims were to search for, summarise and critique the qualitative literature regarding general practitioners' views on spirituality and their role in relation to spiritual care. An integrative review was made by a multidisciplinary team using a critical realism framework. We searched seven databases and completed thematic and matrix analyses of the qualitative literature. A number of good-quality studies exist and show that some but not all GPs are willing to offer spiritual care. Four patterns of attitude towards delivering spiritual care emerge from the studies which indicate different levels of engagement with spiritual care: embracing, pragmatic, guarded and rejecting. Further research is needed to identify whether these four views are fixed or fluid, whether training in spiritual care modifies these and whether they relate to patterns of care in practice, or patient outcomes. The authors suggest that some of the difference in viewpoint relate to the lack of clear philosophical framework. The authors suggest critical realism as having potential to facilitate interdisciplinary research and create clearer concepts of spiritual care for GPs.