Milestone

Consolidation

Last updated 13 September 2022
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

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1. Deliver culturally safe care

Know

  • Understand the importance of the role played by Aboriginal and Torres Strait Islander health workers, health liaison officers and cultural educators and mentors in improving communication with, and in providing culturally safe and appropriate healthcare to, Aboriginal and Torres Strait Islander peoples.
  • Understand the value and importance of developing effective relationships with Aboriginal and Torres Strait Islander health workers and health liaison officers.

Do

  • In identifying a patient as being an Aboriginal or Torres Strait Islander, routinely offer involvement of an Aboriginal or Torres Strait Islander health worker or liaison officer in consultations or as part of the care team.
  • Engage with the local Aboriginal and Torres Strait Islander community, including Aboriginal and Torres Strait Islander health workers, health liaison officers and cultural educators and mentors, to develop understanding of local health issues and develop effective partnerships.
Note: If there are no Aboriginal and Torres Strait Islander health practitioners/workers or liaison officers in the local community, it is still important to understand local referral pathways for Aboriginal and Torres Strait Islander peoples and to work effectively with services (even if done remotely) by using effective communication and providing continuity of culturally safe care. It is important for all GPs to attain this competency, to understand the roles of these health professionals and to access education from cultural educators and mentors to better understand how to work effectively in teams to improve health outcomes for Aboriginal and Torres Strait Islander peoples.

Do

  • Routinely ask Aboriginal and Torres Strait Islander patients about their preferences for services that cater specifically to Aboriginal and Torres Strait Islander peoples. These may include:
    • social and emotional wellbeing workers
    • Aboriginal and Torres Strait Islander liaison officers
    • Aboriginal and Torres Strait Islander health workers
    • Aboriginal and Torres Strait Islander health practitioners
    • Aboriginal and Torres Strait Islander mental health workers
    • Aboriginal and Torres Strait Islander–specific health clinics.
  • Routinely ask patients in cross-cultural consultations about their preferences for services that deliver culturally safe and/or gender-concordant care.
  • Improve the quality of culturally safe healthcare by:
    • including language preference and need for interpreter in referral letters
    • including cultural considerations and practices in referral letters
    • where possible, providing health information to patients that is in their main language and/or culturally appropriate to ensure that they are informed prior to attending appointments with other healthcare providers.
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Integrate an understanding of the factors that may impact the quality and effectiveness of therapeutic relationships, including:
    • psychological factors, such as transference and countertransference
    • the power imbalance between doctor and patient
    • the importance of setting and maintaining clear personal and professional boundaries, especially in small communities
    • cultural and linguistic diversity (capabilities 1 and 2)
    • history of trauma and/or negative past experiences with healthcare
    • socioeconomic disadvantage, with concerns about financial cost of care.
  • Identify warning signs that a patient–doctor relationship may not be therapeutic or effective; for example:
    • feeling uncomfortable about seeing a particular patient
    • requests from patients for dishonest or unethical behaviour by the doctor (eg supplying medications that are not clinically indicated, providing incorrect information on legal documentation, taking part in an intimate relationship)
    • situations in which the doctor may be providing a level of care that is outside of their normal practice.
  • Address barriers to effective therapeutic relationships by considering options such as:
    • having open and clear communication with patients about blurring of therapeutic boundaries, unreasonable expectations or inappropriate requests
    • attempting to share responsibility to define and maintain clear boundaries
    • providing trauma-informed care
    • accessing support and advice from colleagues on how to manage any challenges
    • developing strategies to terminate therapeutic relationships if boundaries are not able to be maintained, while maintaining duty of care responsibilities by referring the patient to another doctor to maintain continuity of care.

Know and do

  • Consider the impact of social and cultural determinants of health on disease presentation, including:
    • Aboriginal and Torres Strait Islander status (particularly noting any impacts of intergenerational trauma)
    • culturally and linguistically diverse background, including refugees and asylum seekers
    • LGBTIQ+ identification
    • low health literacy
    • rural and remote location
    • social disadvantage, including people who are unemployed and/or homeless
    • use of illicit substances, including the effects on the children of people who are dependent on these substances
    • severe mental health issues
    • involvement in the justice system
    • disability
    • children living in out-of-home care
    • intimate partner/family violence
    • previous or ongoing trauma.
  • Consider psychological factors that may impact presentation and management of health conditions, such as:
    • patients with complex PTSD or borderline personality disorder may subconsciously attempt to manipulate the health team dynamics
    • patients with severe cognitive impairment or intellectual disability, or who are floridly psychotic, may not be able to easily make their wishes understood.
  • Consider other factors, such as patients who present seeking analgesics but are unwilling to be properly assessed.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Do

  • Structure consultation in a logical sequence.
  • Use nonverbal skills, such as attentive listening, use of silence and understanding visual cues, body language, eye contact, posture and facial expressions to optimise communication with patients.
  • In consultations with Aboriginal and Torres Strait Islander people, be aware of the importance of nonverbal communication and how nonverbal cues may be perceived by the patient. Seek information and support from cultural educators and mentors.
  • Use reflection, and periodically summarise patient history by ‘checking back’ to verify own understanding and inviting patient to correct interpretation.
  • Encourage patient to express how they are feeling.
  • Actively determine and appropriately explore patient’s feelings, ideas, concerns and expectations.
  • Attend to timing of consultation and ensure that history-taking and examination remain focused on presenting symptoms to optimise diagnostic accuracy.
  • Consider whether to negotiate time alone with adolescents who present with an adult guardian (eg if there are cues that they may wish to discuss sexual health issues, such as contraception, understanding of sexual consent, and/or there is a concern about their ability to recognise unwanted sexual experiences).
  • Consider whether to negotiate time alone for individuals presenting with a partner or family member if there are concerns that there may be abuse or violence being perpetrated.

Do

  • Use respectful, effective communication skills to identify priorities and negotiate an agenda; for example:
    • asking patients about their ideas, concerns and expectations
    • confirming list of presenting problems and screening for other problems
    • re-prioritising issues if other issues arise during consultations, and communicating about impacts of this on ability to cover Patient’s agenda and priorities in current consultation, with potential need for follow-up appointment to cover issues adequately
    • using reflection and regularly ‘checking back’ with patients, summarising issues discussed to clarify that information has been communicated correctly.

Know

  • Understand that confidentiality is central to an effective therapeutic relationship and that assessment of capacity to provide consent is an integral part of ensuring ethical practice. Understand limits, including ethical strategies to manage confidentiality and obtain informed consent.
  • Understand legislative requirements regarding care of individuals who are unable to provide consent, including temporary and ongoing medical power of attorney, guardianship arrangements and advance care directives.

Do

  • Identify the range of people who may expect to be consulted regarding a patient’s care, including family members, carers, staff in residential aged care facilities and interpreters.
  • Ensure that specific informed consent is received from the patient to discuss health issues with family and/or carers.
  • Advise family members of the importance of confidentiality and of not providing confidential patient information without consent.
  • Communicate effectively with family members, carers and substitute decision makers. While acknowledging that the doctor’s prime duty of care is to the patient, recognise impacts of provision of care on family members and carers and shared goals, and incorporate views of these individuals into management plans, where relevant.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

Do

  • Maintain quality clinical records, including:
    • next-of-kin contact details
    • allergies and drug reactions
    • social history, including lifestyle factors such as cigarette smoking, alcohol intake, diet and exercise
    • family history that identifies any inheritable conditions
    • contemporaneous progress notes that clearly outline information gleaned from history, examination and clinical tests combined with past history and risk factors, to inform a diagnosis or concise list of differential diagnoses, including red flag conditions that need to be further investigated
    • clinical notes that are comprehensive enough to allow another health practitioner to review the patient in the near future and understand the clinical problem-solving that has occurred to date, and the current plan
    • a concise management plan, including planned investigations, pharmacological and non-pharmacological management, and plan for follow-up
    • effective use of recalls and reminders
    • up-to-date medication summaries
    • use of My Health Record with patient consent, to optimise continuity of care.

Know and do

  • Identify and understand barriers to care and advocate for these to be addressed.

Do

  • Advocate for patients, particularly those from priority population groups who have social, cultural and/or environmental determinants that may adversely impact their ability to advocate for themselves; for example, poor health literacy, experiences of trauma, and cultural and/or language barriers.
  • Advocate for individual patients who have issues with equitable access by coordinating patient care with external health professionals using a strategic, holistic, person-centred approach, and effective communication and goalsetting.

Do

  • Consider referrals to allied health and specialist care for the most appropriate and beneficial tests, procedures or specialist opinion, taking into account what would be of the most benefit to the health and wellbeing of the patient, the balance between potential benefits, the evidence base, the possible risks and costs and the sociocultural beliefs of the patient.
  • Identify barriers to care and advocate that these be addressed, which may include providing an explanation of biopsychosocial-cultural barriers to care in referral letters to other services. Barriers may include:
    • diversity – cultural, gender, sexual or linguistic
    • disability
    • low health literacy
    • concomitant substance use
    • past trauma, which may impact ability to trust health professionals
    • psychiatric illness; for example, delusional disorders that may impair insight or judgement
    • ineligibility for Medicare or financial barriers
    • difficulties accessing transport.
  • Consider appropriateness of referrals to minimise fragmentation of care.
  • Consider appropriateness of referrals with regard to cost to the patient and timeliness of appointment, to ensure there is minimal risk of health deterioration due to long wait times.
  • Organise referrals in an efficient way, using clear communication to minimise the risk of unnecessary repetition of investigations or therapies that can be burdensome to patients and the broader community.
  • Provide timely and high-quality referral letters to professionals with the appropriate skills to meet the patient’s needs, and who fulfil any other patient needs (eg gender-concordant care).
  • Provide referral documentation that:
    • contains adequate information to accurately identify the patient, including an individual healthcare identifier, if available
    • contains sufficient information to assist the allied health or specialist professional to provide quality care (eg clear reason for the referral, current and relevant past history, family history, medication list, allergies, vaccination status, need for an interpreter)
    • is clear as to its purpose (eg opinion on diagnosis or management, request for therapy)
    • follows completion of an appropriate work-up and includes the results in the referral letter, where appropriate (eg recent liver function tests for an individual with hepatitis B being referred to a liver clinic).
  • Maintain patient confidentiality by:
    • not disclosing sensitive information that is not relevant to the referral
    • encrypting referrals sent electronically (practices must comply with standards for secure transmission of health information).
  • Provide health information to patients who request referrals to help them understand the potential risks posed by undergoing procedures prior to their specialist appointment.

Do

  • Use eHealth systems to:
    • allow another practitioner to continue the care of patients
    • help reduce patient harm and adverse events, and enhance communication between health service providers
    • enable clinical audits of medical records to evaluate the appropriateness of care and how well it aligns with recommendations
    • record key patient information, including:
      • patient demographics (name, date of birth, gender, contact details, next-of-kin details, Medicare number)
      • cultural status, including Aboriginal and Torres Strait Islander status and migration history (to assist with risk assessment and advice)
      • preferred language (and whether an interpreter is required)
      • medical information (allergies, up-to-date list of health problems)
      • medication (up-to-date list)
      • family history (particularly inheritable conditions relevant to the individual)
      • social and occupational history (relationship status, sexuality, gender identification, education level, type of occupation)
      • lifestyle risk factors (eg smoking, alcohol intake, illicit drug use)
      • health screening (whether up to date with developmental screening, blood pressure, mammograms, cervical screening tests, annual diabetes assessments, etc).
  • Competently use a range of eHealth systems; for example:
    • clinical software
    • telehealth/videoconferencing facilities
    • My Health Record
    • encrypted email to transfer patient information
    • health tools and applications available for professionals and patients (eg e-mental health interventions).
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Do

  • Conduct a structured and rational approach to assessment, including:
    • taking a concise, focused, and patient-centred history
    • completing relevant and respectful examinations using appropriate equipment
    • identifying individuals who have had a traumatic experience that may impact their capacity to trust or tolerate discomfort, or that may create a perception of loss of control in consultations
    • using available clinic tests
    • using appropriate assessment and screening tools
    • identifying patients who are significantly ill or at risk of acute clinical deterioration (competency 5.3.6)
    • accessing clinical support appropriately and as required.
  • Establish a working diagnosis or a rational list of differential diagnoses that identifies red flag conditions and high probability acute conditions.
  • Understand the limits of own skills and knowledge and seek help appropriately (competency 13.1.3) if unable to distinguish the likely diagnosis and/or if unsure how to investigate or manage the symptoms or condition.
  • If in need of advice:
    • logically and concisely present assessment findings and explain approach to clinical problem-solving to a senior supervising doctor
    • explain plan for investigation and/or procedures required and initial safe management of the presenting problem, to enable advice and feedback to be provided.
  • Use examination skills to identify relevant positive or negative findings, including:
    • cardiovascular, respiratory, gastrointestinal, cranial nerve and limb neurological examination
    • eye, ear, nose and throat examination
    • joint examination, including cervical, thoracic, lumbar spine, knee, hip, shoulder, elbow, wrist, ankles, hand and foot
    • thyroid, breast, pelvic and genital examination in men and women.
  • Use relevant equipment for examination, including:
    • visual acuity charts
    • ophthalmoscope +/– panophthalmoscope +/– slit lamp
    • Amsler grid and Ishihara chart
    • auroscope (including visualisation of tympanic membrane in uncooperative children)
    • tuning fork for Rinne and Weber tests
    • monofilament
    • magnifying instrument to examine skin lesions +/– dermatoscope
    • peak flow meter and spirometer
    • ECG (and interpret for atrial fibrillation; atrial flutter; supraventricular tachycardia; ventricular fibrillation; atrial and ventricular ectopics and ischaemia; first-, second- and third-degree heart block).
  • Use relevant assessment tools.
  • Identify and ascertain impact on differential diagnoses of positive and negative physical signs.
  • Identify common acute symptoms (typically not severe or life-threatening).
  • Practise rational safe prescribing using clinical guidelines as appropriate (competencies 6.3.4 and 14.3.1).

Do

  • Effectively triage and manage time to assist in prioritising patients to be assessed.
  • Consider:
    • current symptoms and severity
    • how long symptoms have been present
    • whether the individual recently travelled to an area at high risk for communicable diseases
    • existing vulnerabilities and thus a risk of acute deterioration (eg age and existence of concomitant illness).
  • Stratify and prioritise differential diagnoses according to level of risk by assessing the patient’s risk of having a disease state based on the information available and consideration of the potential severity of this condition. In taking a history, elicit clinical flags and other risk factors, particularly family history and mode of inheritance of the condition, as well as lifestyle factors, concomitant disease and medication history.
  • Use clinical flags to assist in prioritisation. Clinical flags include:
    • red (possibility of serious pathology)
    • yellow (psychosocial pointers that may indicate risk of progression to long-term distress, disability and/or pain)
    • orange (psychological equivalent of red flags: suggest need for mental health review)
    • blue (perceptions about the relationship between work and health that may inhibit recovery)
    • black (systemic or contextual obstacles related to particular people, systems or policies).
  • Consider all relevant factors to assist in recognising the multidimensional aspects of conditions, particularly pain, and to assist in risk stratification and developing a meaningful management plan.
  • Consider referral for appropriate tests and procedures and/or for specialist opinion.
  • Provide a rational approach to ordering investigations and/or diagnostic procedures based on:
    • the key purpose of the investigation(s)
    • likely benefits versus any risks to the individual
    • evaluation of the validity, sensitivity and specificity
    • relevant guidelines
    • MBS criteria, where relevant
    • costs to the individual and/or broader population.

Do

  • Demonstrate rational decision making and correct processes for procedures, including:
    • choosing the appropriate procedure
    • communicating clearly with the patient
    • obtaining and documenting informed consent
    • safely performing the procedure using strict infection control standards, including safe management of sharps and body fluids
    • accurately documenting what took place
    • organising appropriate aftercare, including advice on when to return for review.
  • Understand the limits of own procedural skills and practice requirements prior to undertaking a procedure, and organise appropriate supervision to optimise patient safety.
  • Safely undertake common procedures.

Know

  • Use competencies 5.3.1, 5.3.2 and 5.3.3 to gather adequate clinical data to inform and prioritise a rational list of differential diagnoses. Use guidelines, as appropriate, and experiential knowledge to generate a high probability diagnosis, if possible.
  • Interpret investigation results in the context of the patient’s history and examination findings, identify likely causes of any abnormal findings and explain significance to the patient in the context of their current symptoms, health status and any comorbidities.
  • Clearly explain and manage common abnormal pathology and radiology results, including:
    • anaemia: micro, macro and normocytic
    • iron, B12 and folate deficiency
    • elevated creatinine, including acceptable levels in individuals with chronic renal impairment
    • abnormal liver function tests
    • low platelets
    • proteinuria
    • haematuria
    • electrolyte abnormalities (eg high or low potassium, high or low sodium)
    • elevated or reduced thyroid-stimulating hormone with normal or abnormal T3, T4
    • disc prolapse on CT spine scan of individual with no back pain.
  • Manage uncertainty by developing a safe management plan, including continuity of care, and explore other differential diagnoses (including possible biopsychosocial-cultural contributing factors) if it is not possible to define the final diagnosis (refer to competency 5.3.8 for further criteria regarding management of uncertainty, safety netting and use of time as a diagnostic aid).

Know

  • Understand importance of adequate follow-up, including an assessment of the urgency and importance of the reason for follow-up.
  • Describe the factors that may affect either the patient’s or the doctor’s ability to follow up appropriately, such as barriers to follow-up or where errors may occur that lead to lack of follow-up.  
  • Know the practice systems that facilitate timely follow-up, including recalls, reminders, handover and clinical notes. 

Do

  • Prioritise the urgency of follow-up and proactively follow up patients appropriately.
  • Make appropriate plans for follow-up and ensure the patient understands the plan.
  • Use practice systems to ensure follow-up occurs.

Know

  • Know the signs and symptoms of severe illness in different age groups and patient cohorts, including:
    • indicators of a ‘sick child’, including signs of dehydration, hypovolemia, and respiratory distress in children of different ages:
      • in infants – reduced feeding and looking ‘floppy’ when unwell, signs of dehydration and increased respiratory effort and decompensation (eg cool peripheries, greater respiratory rate with increased work of breathing, poor skin turgor, sunken fontanelle)
      • in toddlers – uninterested in playing or engaging with surroundings, tachycardia (usually the first physical sign of decompensation)
    • in fit young adults – drop in blood pressure, severe tachycardia, etc
    • in older people or those with chronic conditions – hypotension and tachycardia (may be masked by pre-existing conditions; eg heart block or use of medications such as calcium channel or beta blockers), etc.

Do

  • Put in place an efficient treatment plan to optimise outcomes; for example, rapidly prioritise issues to manage, including the DRSABCD action plan (Danger, Response, Send for help, Breathing, CPR, Defibrillation), in line with Australian Resuscitation Council guidelines.
  • Ensure effective clinical handover (either verbal or written) in emergency situations. The ISBAR framework is a useful structure for efficient clinical handover:
    • Introduction (describe role and purpose of communication)
    • Situation (current status of the patient)
    • Background (concise summary of issues that led to the presentation, including past history, medications, allergies and relevant risk factors)
    • Assessment (outline of the problem with key clinical signs, working diagnosis and management instituted)
    • Recommendation (what is needed).

Know

  • Demonstrate skills in advanced life support, including:
    • airway management skills, bag and mask ventilation, insertion of oropharyngeal airway, including laryngeal mask airway
    • emergency scene management and safety
    • establishing venous access
    • defibrillation and cardioversion.

Know

  • The psychological causes of undifferentiated symptoms, particularly repeat presentations; for example:
    • causes of non-accidental injury (including concerns about intimate partner or family violence)
    • individuals at risk of intentional self-harm (eg misuse of medication, disordered eating, cutting) such as occurs in borderline personality disorder or complex PTSD, or recurrent somatic complaints that remain undifferentiated despite investigation where there is a suspicion that there may be a psychological basis
    • stress related to being a carer, recent bereavement, work/career or financial difficulties or potential for secondary gain
    • Munchausen syndrome or Munchausen by proxy.

Do

  • Identify patients with acute undifferentiated conditions who are significantly unwell or at risk of acute clinical deterioration as per competency 5.3.6.
  • Access support from a senior colleague in a timely way if unsure how to investigate or manage a presentation.
  • Rationally choose investigations and management and balance the potential risks (of both under- and over-investigating and management) against the benefits to the individual.
  • Use the ‘diagnostic pause’ appropriately.
  • Be familiar with serious conditions that must not be missed, conditions commonly missed, and conditions that may present with unusual or elusive symptoms.
  • Reduce risk by organising follow-up and review.
  • If appropriate, inform the patient of the signs of deterioration and provide options for them to access medical review in a timely way.
  • Acknowledge that some symptoms and presentations may never be attributed to specific conditions.
  • Develop strategies for delineating the physical and psychological components when psychological conditions present as physical symptoms.
  • Deliver trauma-informed care.
  • Use a multidisciplinary approach and professional support to ensure that diagnoses are not missed.
  • Be clear about decisions and refer to evidence during history-taking, examination and investigations, to maximise diagnostic effectiveness and patient safety and minimise over-investigation.
  • Use evidence-based approaches to assessment and management to clarify and strengthen decision-making.
  • Use effective communication skills to manage patient anxiety when there is uncertainty and/or when managing undifferentiated conditions of a psychogenic origin, and to communicate management options and expected outcomes.

Know

  • Be informed about public health risks, including:
    • notifiable communicable diseases (eg hepatitis A, giardia, rotavirus, salmonella)
    • STIs (eg chlamydia, gonorrhoea, syphilis, human papillomavirus [HPV])
    • vector-borne diseases (eg malaria, dengue fever)
    • airborne viruses (eg influenza, tuberculosis), including pandemic influenzas, novel coronavirus
    • vaccine-preventable diseases (eg hepatitis B, measles, mumps, varicella, tetanus, polio, meningococcus, haemophilus)
    • blood-borne viruses (eg HIV, hepatitis C)
    • infections spread by contact (eg chlamydial eye infections)
    • potential environmental hazards (eg water quality, respiratory effects of pollution)
    • occupation-related hazards (eg asbestos exposure).
  • Understand own state or territory requirements for reporting of notifiable conditions and relevant time limits.

Do

  • Make notifications to own state or territory department of health and assist with contact tracing once informed consent has been provided regarding STIs and communicable diseases (eg active pulmonary tuberculosis, pandemic management).
  • Implement vaccination programs with appropriate education.
  • Identify health concerns in the local community (eg related to occupational or environmental risk factors) and manage these through advocacy and professional support.
  • Stay informed of disease trends and guidelines regarding screening and prevention.
  • Improve health outcomes by identifying vulnerable groups and detecting or preventing disease.
  • Use a team approach within practice setting to identify and manage individuals with communicable diseases.
  • Manage communicable disease outbreaks, including by:
    • effectively triaging febrile patients
    • using infection control procedures
    • using medical isolation appropriately
    • vaccinating vulnerable members of the population
    • using the communicable disease notification framework
    • contact tracing after diagnosis
    • educating patients, family members and/or carers on effective minimisation of transmission
    • communicating efficiently with hospitals prior to patient transfer.
  • Participate as required in public health initiatives; for example, health education and promotion campaigns, implementation of vaccination programs and advocacy regarding issues of public health concern.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Do

  • Develop management plans for common chronic conditions that take into consideration:
    • evidence-based pharmacological and non-pharmacological approaches
    • physical, social and psychological therapeutic modalities
    • which options will be of most benefit to the health and wellbeing of the patient
    • the patient’s sociocultural beliefs
    • the balance between risk of side effects, interactions and costs.
  • Consider management options such as physical, social and psychological therapeutic modalities that are likely to be of most benefit to the health and wellbeing of the individual, considering sociocultural beliefs and balancing the risk of side effects, interactions and costs. These may include:
    • advice on exercise regimens, dietary improvements and sleep routine
    • adequate sun exposure
    • involvement in community activities
    • stress management techniques
    • communication strategies
    • conflict resolution with significant others
    • avoidance or minimisation of exposure to risk factors (eg smoking, alcohol, illicit substances, environmental pollutants)
    • pharmaceuticals
    • herbal or nutritional supplements
    • referrals for physical or psychological therapy, or to other non-GP specialists for different forms of intervention or management
    • addressing impacts of social determinants of health that may be contributing to the condition, or any potential for development of complications due to barriers to care access.
  • Provide continuity of care and appropriate follow-up.

Do

  • Provide effective counselling, in language appropriate to the individual and their sociocultural context, regarding management options and models of care to enable informed consent and shared decision-making and to develop collaborative goals of care.
  • Consider using therapies and recommendations for lifestyle interventions to improve quality of life, reduce risk of complications and prolong life.
  • Consider and discuss with patients and their families or carers, where appropriate, care versus cure management (eg palliation versus active treatment for advanced cancer, severe ischaemic heart disease, incurable chronic condition).
  • Consider a variety of models of care, including:
    • cure
    • rehabilitation
    • palliation and voluntary assisted dying (in states and territories where legislation is in place to support this)
    • health promotion and prevention with focus on lifestyle modification
    • delivery of care to priority population groups
    • specialised general practice (eg sports medicine, military medicine, sexual health)
    • care for specific populations (eg options for obstetric care and delivery).

Do

  • Provide patient-centred, collaborative care.
  • Discuss impacts of the condition on the individual patient, their relationships, their ability to work and/or study and to undertake their activities of daily living, as well as their psychological wellbeing and financial situation.
  • Recognise the impacts of burden of care on family members and carers; for example:
    • identify signs of stress in carers (particularly in instances of chronic mental health issues, older patients with intensive needs, individuals with sensory, physical or intellectual disabilities, individuals who are receiving end-of-life care, etc.)
    • discuss and organise respite, as required
    • identify grief reactions, distress and fatigue
    • identify signs that carers are not coping with their workload and provide support and advice regarding management
    • support family and carers with bereavement.
  • Provide support and education to optimise wellbeing and promote self care; for example:
    • provide socioculturally appropriate verbal and written information on health promotion activities
    • use psychological techniques, such as motivational counselling, cognitive behavioural therapy and mindfulness to encourage and sustain behavioural change.

Know

  • Be aware of statutory requirements; for example:
    • definition of drug-dependent person
    • Schedule 8 medication prescribing, including criteria for permit
    • requirements for additional training prior to prescribing some restricted medications (eg opioid substitution therapy).
  • Understand availability of most appropriate guidelines for different classes of medication and how to access current versions of these.
  • Know the local resources that are available to assist with safe prescribing and optimising patient concordance; for example:

Do

  • Prescribe medication according to indications and in line with guidelines.
  • Use unbiased evidence-based resources to guide prescribing; for example, for antibiotics, analgesics, psychotropics and other common acute and chronic conditions (competencies 6.2.3 and 14.2.1).
  • Select the most appropriate medication for the individual patient, considering factors such as:
    • ability to metabolise and tolerate medication (eg age, renal and hepatic impairment, other comorbidities)
    • age – especially children, elderly
    • comorbidities
    • pregnancy and lactation
    • interactions with other medications, including over-the-counter medications or contraindications (eg oral contraceptives, hormone replacement therapy, beta blockers, drug sensitivities, anticoagulants and antidepressants)
    • capacity for patient to manage complex dosing and access appropriate monitoring, if required
    • the need to balance potential benefits against potential risks, and discuss these with the patient.
  • Educate patients on use of commonly prescribed medication devices, including:
    • different types of inhalers and spacers
    • adrenaline auto-injectors
    • insulin pens.
  • Follow up to monitor for side effects, assess effectiveness and concordance.
  • Facilitate concordance by:
    • providing socially, culturally and language-appropriate resources (eg multilingual patient information, Easidose prescribing aid)
    • effectively communicating with patients about the role of medications, including discussion about patient concerns or reticence
    • ensuring patients are aware of how and when to make contact if they have concerns about a medication or side effects
    • provide counselling regarding use, benefits and common side effects of common medications
    • referring to other services, including pharmacist for home medicine review or provision of packaged medication (eg medication packs), or the district nursing service; enlist family help to assist with medication management if there are safety or concordance concerns.
  • Conduct appropriate therapeutic monitoring, including for:
    • medications with a narrow therapeutic range to minimise risk of toxicity (eg warfarin, lithium, digoxin and phenytoin)
    • individuals at risk of, or who experience specific side effects from, prescribed medications; for example, kidney function tests (UEC) after commencement of angiotensin-converting enzyme inhibitors in individuals at risk; indications for creatine kinase monitoring with statins.
  • Manage drug withdrawal symptoms, including for individuals with prescription drug dependence (eg benzodiazepines, opioid and other analgesic medications and antidepressants).
  • Undertake safe and rational private and off-label prescribing and provide appropriate counselling to patients (eg about review or follow-up processes required to ensure that adverse effects are detected early).
  • Appropriately report adverse side effects to relevant authorities.
  • Undertake prescribing of common medications and counsel patients regarding their use.
  • Understand clinical uses of and, where appropriate, provide advice on safe use of commonly used integrative therapies.
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

Know

  • Understand the principles of good screening tests.
  • Understand the types of health promotion and education that are typically required at different life stages and the engagement strategies that are most effective for priority population groups.
  • Understand the breadth of social and epidemiological, non-modifiable and modifiable risk factors for common acute and chronic conditions to assist in identification of individuals who may benefit from preventive care to improve outcomes. These include:
    • gender and age
    • ethnicity/country of origin
    • if sexually active
    • lifestyle risk factors (eg diet, exercise, smoking, alcohol intake, substance use)
    • biometrics (eg BMI, neck and waist circumference)
    • family history (of inheritable conditions)
    • occupational history (eg asbestos and dust exposure)
    • comorbidities
    • socioeconomic status
    • previous trauma experiences.

Do

  • Use recall systems and flags in patient records for reminders regarding vaccinations, age- and risk-based screening, and where appropriate, prophylactic treatment for those at risk, as well as opportunistic screening when risk factors are identified based on established guidelines.
  • Identify patients, particularly those with low health literacy, who would benefit from opportunistic or planned health promotion education to prevent injury and/or disease.
  • Identify and notify individuals in need of follow-up; for example, for further investigation or specialist referral after routine screening or abnormal results.
  • Undertake opportunistic screening of priority population groups.
  • Prior to screening, counsel individuals appropriately of potential outcomes if result is positive or negative to ensure that they are adequately informed.
  • Use screening and prevention strategies appropriately.
  • Provide life stage–based screening, preventive health assessments and opportunistic counselling.
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