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.

Compare competencies of the roles at different milestones

8. Rationally and responsibly use the healthcare system

Do

  • Consider the economic costs of each consultation.
  • Ensure compliance with MBS and PBS requirements regarding eligibility for scripts, consultations, referrals, use of case conferences, health assessments and management plans.
  • Provide rational referrals for pathology and radiology investigations in line with guidelines.

Know

  • Maintain current knowledge of MBS and PBS criteria and updates.
  • Know where to access current information on the criteria for billing item numbers and prescribing medications.
  • Understand patient entitlements; for example: government healthcare cards, DVA cards, age and disability pensions, NDIS, private billings for third-party insurance funding for motor vehicle accident injuries and workers compensation.

Do

  • Appropriately use Medicare item numbers; for example, for:
    • Aboriginal and Torres Strait Islander health assessments
    • Healthy Kids Check
    • type 2 diabetes risk evaluation
    • health assessment for people aged 45–49 years
    • mental health–focused psychological strategy and mental health assessment and plan
    • care plans for children with eligible disabilities
    • chronic disease management plans/team care arrangements for individuals on low incomes
    • health assessment of residents of residential care homes
    • health assessment of people with intellectual disability
    • case conferencing
    • use of life-threatening emergency item numbers
    • refugee health assessments
    • health assessment for people aged 75+ years and older
    • medication management reviews for diabetes, asthma and individuals with multimorbidity requiring multiple medications
    • cervical smear cycles of care
    • post-military discharge health assessments
    • DVA-funded care for eligible military veterans.
  • Review and compare investigation referral patterns with peers through formal audits or discussions (to ensure that referral patterns are reasonable and rational).

Do

  • Use an evidence-based approach to making referrals and consider the balance between potential benefits and the possible risks and costs.
  • When choosing investigations consider:
    • the purpose of referral for investigation and whether a positive or negative result will alter the management plan
    • the evidence base of the different investigation options
    • the validity, sensitivity and specificity of the investigation options
    • the cost and risks of investigations (both to the patient and to society through Medicare funding).
  • When referring a patient for investigations, consider and discuss:
    • potential harm caused by some investigations (eg multiple CT scans)
    • sensitivity and specificity of some tests (eg PSA), including information on false positives and false negatives
    • if further investigation and treatment poses risks
    • pre-test counselling for blood-borne viruses in an individual who is at risk of possible exposure to ensure that the concept of the window period and need for follow-up is understood
    • risks, costs of investigations and treatment options in the event the investigations are suggestive of disease
    • financial costs of the investigation and potential for increased insurance costs if a suspected diagnosis is confirmed (eg Factor V Leiden heterozygote)
    • the possible implications of predictive predisposition testing for later onset disorders (eg if few treatments or risk-mitigation strategies are available, if treatment involves risks, or if the development of the condition is not a certainty).
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

9. Identify and address contributors to health inequity and advocate for care access

Know

  • Understand the concepts of sociocultural determinants and intersectionality.
  • Understand that intersectionality and sociocultural determinants complicate identification, the ability to prioritise and manage chronic health problems (eg individuals who are homeless, refugees and asylum seekers, individuals with disability, individuals with substance dependency issues or who have been exposed to family violence).

Do

Identify the key determinants in the local community population and impacts of disease prevalence, presentations and access to care. These may include:
  • cultural and linguistic diversity
  • financial insecurity
  • poor access to employment and education
  • level of health literacy
  • adverse childhood experiences
  • poor access to adequate or safe housing
  • exposure to occupational risks
  • exposure to violence, addiction and intergenerational trauma
  • social support and exclusion (eg stigma, racism, sexism, ableism, acceptance of gender identity and sexual orientation, contact with criminal justice system, quality of family and community relationships)
  • environmental influences on health, such as:
    • consequences of climate change (eg extreme weather events, impacts of forced migration, increased temperatures leading to introduction of new vector-borne diseases)
    • geographical location of practice (eg an area at risk of natural disasters)
    • airborne allergens, pollution and occupational exposures (eg asbestos, lead, dust, chemicals, radiation, flammable liquids, gases).

Know and do

Identify priority population groups in local community and prevalent health issues (competency 9.1.1); identify referral pathways and resources available to these groups to improve health and reduce risks. Refer also to competencies 1.3.1 and 1.3.2.

Do

  • Maintain a broad overview of the local community. Consider disease prevalence trends, social determinants and any associated barriers to healthcare access.
  • Identify the diversity of the local population, including:
    • Aboriginal and Torres Strait Islander peoples
    • cultural and linguistic diversity
    • occupational diversity
    • gender and sexual diversity
    • people with disability
    • socioeconomic diversity.
  • Identify frequently encountered barriers to healthcare access for specific populations in the local community; for example:
    • lack of access to interpreters or appropriate health resources (eg not culturally appropriate or in primary language)
    • non–culturally safe care
    • physical access difficulties or other barriers for people with disability (eg challenging environment from a sensory perspective for people with autism spectrum disorders)
    • geographical and financial
    • access to public transport.

Be

Inquisitive about health inequities and interested in advocating for improved access and health outcomes.
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