The General Practitioner in Australia
Quality general practice is the foundation of an effective and efficient Australian healthcare system. The RACGP defines general practice as the provision of person-centred, continuing, comprehensive and coordinated whole person healthcare to individuals and families in their communities.
General practitioners typically provide the first point of contact for optimising wellbeing of patients and the health of the wider community. Through providing quality continuity of care, effective health education and health promotion and early intervention, the general practitioner supports arguably the most cost and clinically effective service within Australia’s healthcare system and the most commonly accessed provider of healthcare. In 2011-2012 census 81% of people reported that they saw a GP in the previous 12 months. (Australian Bureau of Statistics, 2013).
General practitioners possess unique skills as medical specialists. These skills enable them to provide truly holistic and patient centred care to a diverse range of individuals no matter where they are located. There are general practitioners providing service to individuals and communities that are seldom visited by any other medical specialist. For this reason, the general practitioner needs to be able to adapt their skills to whatever situation they encounter. In the Australian setting the diversity of settings can include everything from rural and remote communities to densely populated metropolitan centres. General practitioners practice out of well-equipped offices, Aboriginal Health Services, base hospitals, war zones, schools, community centres, under trees and in the air. Their encounters cover patients across the lifespan and the multicultural and socioeconomic spectra, presenting with both undifferentiated and well differentiated, often multisystem and complex illness. The general practitioner treats each patients mindful of the economic and potential public health impacts of the consultation.
The provision of general practice services requires the application of high level problem solving skills and the sensitive but assertive management of uncertainty. The general practitioner incorporates evidence based knowledge to develop a diagnostic hypothesis that is ranked according to probability, potential severity and treatability. Where evidence is lacking, the general practitioner uses safe, innovative strategies to manage each situation.
General practice involves the ability to take responsible action on any medical problem that the patient presents, whether or not it forms part of an ongoing patient-doctor relationship. The general practitioner may see health problems present in their physical, psychological, spiritual, social and cultural dimensions and will develop holistic strategies for dealing with them.
In managing the patient, the general practitioner may make appropriate referral to other doctors, healthcare professionals and community services. However, the initial diagnosis and management of clinical presentation is undertaken within the context of general practice and by the general practitioner. To maximise the opportunities for care for the patient, the general practitioner collaborates with an extensive, multidisciplinary referral networks to optimise health outcomes for individuals within the sociocultural context and the available resources of their community.
General Practice Education Framework
The RACGP Education Framework depicts the ways in which the RACGP policies, pathways and processes support with the general practitioner at every stage of his or her development in the specialty of general practice. The Framework is both a blueprint and a guide to assist all stakeholders navigate the educational journey of general practice. It is supported by robust policies and underpinned by a number of key documents;
- The curriculum for Australian General Practice
- The competency profile of the Australian General Practitioner
- The Standards for General Practice Training
There are three clearly defined stages of the educational journey as outlined in the RACGP Education Framework and defined in the learning outcomes contained in the Core Skills unit of the Curriculum for Australian General Practice. These three stages are;
- Pre-general practice
- General practice under supervision
- General practice – lifelong learning
Pre-general practice encompasses the progression and development of generic medical skills and knowledge with the endpoint being entry into the next phase, general practice under supervision. There are a number of pathways through general practice under supervision that accommodate both Australian and overseas doctors with varying amounts of previous experience but to enter this phase, all must meet the competencies of pre-general practice documented in the RACGP Curriculum for Australian General Practice (link).
The Competency Profile of the Australian General Practitioner defines the general practitioner at the point of Fellowship. It incorporates the competencies that define the end of general practitioner under supervision but also clearly articulates the qualities, skills and abilities that define the general practitioner and the specialty of general practice.
General practitioners are expected at a minimum, to maintain competence in accord with the elements outlined in the Competency Profile throughout their professional life. It can be applied to assess or verify the competence of any general practitioner at any stage of their professional life post-Fellowship. The Competency Profile can be used to pinpoint areas for remediation and further development.
The endpoint of general practice under supervision is the award of Fellowship of the Royal Australian College of General Practitioner.
The final stage of the journey, general practice – lifelong learning, is where the Australian general practitioner will spend the vast majority of his or her professional life. There are no endpoints for this stage as the general practitioner continually updates and develops their skills and knowledge based through clinical activity and further professional development. The core skills in this section are not exhaustive in recognition of the on-going nature of learning and the continuous discovery of new evidence that informs the general practitioner and the specialty of general practice.
The RACGP Education Framework is organic and will change and adapt to circumstances as the health needs of the Australian community evolve and as new evidence emerges. The RACGP Education Framework outlines a continuous and purposeful development path to support the educational needs of the general practitioner throughout her/his professional life.
Australian Bureau of Statistics, Patient Experiences in Australia: Summary of Findings, 2012-13, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4839.0main+features32012-13 accessed 6/11/2015