RACGP National Rural Faculty
Rural general practice - Definition
The term ‘general practice’ is not consistently used in international literature. In Australia, The Royal Australian College of General Practitioners defines it as follows:
General practice provides person centred, continuing, comprehensive and coordinated wholeperson health care to individuals and families in their communities.
As a sector, general practice, its practice teams and their primary health care relationships comprise the foundations of an effective health care system. As a relationship based specialist medical discipline, general practice clinicians are defined by the characteristics of their discipline, which are:
person centredness: general practitioners understand that health, illness and disease are ultimately personal experiences, and that their principal role is to relieve personal dis-ease in all its forms, in the manner best suited to each individual. The patient's needs, values and desired health outcomes always remain central to the general practitioner's evaluation and management processes.
continuity of care: long term relationships build mutual knowledge, understanding, and trust: all essential elements in a therapeutic relationship which generates the potential for healing, empowerment and beneficial change. General practitioners seek to build health, wellbeing and resilience through the continuing patient-doctor relationship, application of best available evidence in the unique context of each consultation, and planned coordination of clinical teamwork, resources and services.
comprehensiveness: general practitioners are not limited by age, gender, body system, disease process or service site. The scope of clinical practice is challenging, spanning prevention, health promotion, early intervention for those at risk, and the management of acute, chronic and complex conditions within the practice population whether in the home, practice, health service, outreach clinic, hospital or community.
whole person care: appreciation of the interplay between bio-psycho-social contributors to health leads to a deep understanding of the whole person, and the ability to manage complex conditions and circumstances. The general practitioner functions as a physician, counsellor, advocate and agent of change for individuals, families and their communities.
diagnostic and therapeutic skill: general practitioners' high level diagnostic and therapeutic skills applied within continuing relationships deliver cost effective care that is highly valued by patients. General practitioners are skilled in managing uncertainty, undifferentiated illness and complexity, able to utilise best practice evidence in the light of individual circumstances, and engage patients and families in understanding, planning and managing their health according to individual capacities.
coordination and clinical teamwork: general practitioners work in close and respectful relationships to deliver accessible, integrated patient care: leading, supporting and coordinating their flexibly configured clinical teams; contributing appropriately to external clinical teams, and engaging with diverse specialists and other sector services according to individual patient or family needs. The general practitioner is increasingly the custodian of, and conduit for, key patient clinical information.
continuing quality improvement: general practitioners are able to assess their professional capabilities, expand existing skills and acquire new skills over a professional lifetime in response to changing clinical and community contexts. At the practice/service level, quality care requires leadership, teamwork, planning, systematic information management and continuing quality improvement processes to underpin delivery of care at every level.
professional, clinical and ethical standards: professional standards provide general practitioners with the essential framework for decision making in a complex environment where the ethical tensions between providing best possible care for individual patients, the cost effective utilisation of limited public resources and achieving equity for those most disadvantaged, must constantly be considered and resolved.
leadership, advocacy and equity: general practitioners understand the socio-economic and environmental determinants of health and the contribution made by other health professionals, sectors and community groups, resulting in collaboration, advocacy and leadership, influencing local environments to the benefit of individuals, families and communities, especially those most marginalised and at risk.
continuing evolution of the discipline: general practitioners contribute to the evolution of their discipline according to individual interests, skills and circumstances through diverse involvements in teaching, mentorship, research and local health service planning and service development, with all elements understood as being integral to clinical practice, quality care and continuation of a high quality workforce.
General practice is a unique discipline. Rigorous scientific medical training and the ability to apply the evidence appropriately in community settings, places general practice at the centre of an effective primary health care system. These same qualities – when combined with the discipline's holistic, relationship based philosophy and broad generalist practice, distinguish the discipline in large measure from other medical disciplines.
Every person needs a medical home in general practice where the provision of person centred, continuing care is based on the foundations of a relationship of trust between patients and their chosen general practitioner, while its consistent delivery rests with the practice or primary health care service as a whole.
Rural General Practice
Rural general practice provides its own diversity of contexts and characteristics. In rural and remote Australia, geographical and demographic features lead to great diversity in both the ranges of presentations a general practitioner may encounter and the facilities that may be available to them to administer primary care. Research has shown that rural general practitioners are more likely to be able to provide in-hospital care as well as private consulting room care, to provide after hours services, to engage in public health roles expected of them by discrete communities in which there are few doctors to choose from, to engage in clinical procedures, to engage in emergency care, to encounter a higher burden of complex or chronic health presentations, and to encounter larger proportions of Aboriginal or Torres Strait Islander patients in their overall patient load.
The extent to which the GP will engage in any of these activities and roles, however, will depend entirely on the rural or remote context in which they choose to practice, or the range of general practice skills in which they wish to involve themselves. Some rural doctors in smaller rural towns, for instance, are based primarily at the local hospital, but the practice they conduct is still predominantly primary medical care, even though some secondary and, in cases, tertiary care is also possible due to the hospital facilities. Whilst their practice thus conforms to the core curriculum set for its Fellowship by the Royal Australian College of General Practitioners, it will also involve specific skills sets appropriate to the rural and/or remote health context in which they find themselves. These skills sets may be practiced at an extended or advanced level, depending on patient requirements. These characteristics and practices are supported by the RACGP Standards of Practice and a curriculum developed and maintained by the College and reflected in the Fellowship in Advanced Rural General Practice.
The Australian Government can formally recognise a doctor as a general practitioner. This Vocational Recognition allows a GP's services to be eligible for a Medicare rebate. In order to maintain recognition, a GP is required to complete ongoing education. The Commonwealth differentiates general practitioners from ‘specialists’, which the Commonwealth recognises on the strength that they earn more than half of their income by accessing specialist items in the MBS. Accreditation of the RACGP as a specialist medical college by the Australian Medical Council in 2003 reflects the RACGP’s view that a general practitioner is no more or less a specialist than any other medical specialist, and should be remunerated accordingly.