Milestones

The Entry milestone is defined as the point when a doctor is ready to commence in a general practice training program in a general practice setting under direct supervision.

Privilege
The doctor is deemed suitable to commence training in the general practice setting.

Supervision level
In the general practice setting, the doctor must practise under direct supervision, with the supervisor having oversight of every case and carrying predominant responsibility for each patient. The rationale for this is that clinical care in the context of general practice can be very different to previous clinical experiences which may be predominantly hospital based. This level of oversight should continue until the doctor has been judged to have the competencies set out at the Foundation milestone.

Competencies
The competencies defined at this milestone are intended to incorporate the knowledge, skills and attitudes required at the point at which a doctor commences work as a general practice registrar in a general practice setting.

The Foundation milestone is defined as the point at which a doctor has demonstrated the required competencies to transition to indirect supervision with reliable access to supervisory support and close oversight of their practice.

Privilege
The doctor is deemed capable of attending general practice patients under close indirect supervision.

Supervision level
The doctor is considered safe and competent to provide general practice care to patients, taking primary responsibility for management decisions. They are expected to adhere to guidelines on when to escalate the care of a patient to a supervisor. The supervisor monitors the doctor’s performance closely and is reliably available for support as required. The supervisor is responsible for ensuring that mechanisms are in place to monitor the doctor’s quality and safety of practice. This close supervision and support is required until the doctor attains the competencies of the Consolidation milestone.

Competencies
The competencies defined at the Foundation milestone are those necessary to be competent to practise safely without direct supervision. The doctor will need to have demonstrated the foundational clinical knowledge, skills and attitudes to assess common general practice presentations. They will also need insight into the limits of their knowledge and skills and their ability to access help when required; these competencies are fundamental for both patient and doctor safety.^{6, 7, 8}
Assessment of these is largely the responsibility of the supervisor and their team.

The Consolidation milestone is defined as the point at which a doctor has demonstrated the required competencies to work largely independently in the general practice setting. They still require mentorship and occasional supervisory support.

Privilege
The doctor is deemed capable of working largely independently, but with access to support and supervision as needed.

Supervision of practice
The doctor is considered safe and competent to manage a broad range of general practice presentations. The supervisor continues to ensure there are mechanisms in place to monitor whether the doctor is providing quality care, and remains available to provide mentoring, support and advice as requested by the doctor.

Competencies
The competencies defined at the Consolidation milestone are close to those required for independent practice. These enable the doctor to be capable of undertaking assessment and management of a large range of general practice presentations and work with a high degree of self-sufficiency.

The Fellowship milestone is defined as the point at which a doctor transitions to independent practice, having achieved the capabilities required to work as an RACGP Fellowed GP.

Privilege

At this milestone, the doctor is deemed capable to practise safely as an unsupervised GP anywhere in Australia.

Supervision of practice

The doctor is considered suitable for unsupervised practice as a qualified GP in Australia.

Competencies

Transition to this point requires a doctor to have refined and built on the competencies of the Consolidation milestone. They will have demonstrated the capabilities to work as a GP independent of supervision.^{9 10}