Comprehensive Australian General Practice Guidance Document


1. Introduction

This guidance document provides the RACGP’s principles of comprehensive Australian general practice in relation to general practice training.

It also provides guidance on how these principles apply to all GPs in training (GPiT) in ensuring the scope of work undertaken in general practice meets requirements of progression towards Fellowship of the RACGP.

2. Context

2.1 The RACGP uses the term ‘comprehensive Australian general practice’ across different activities relating to general practice. This document provides information specifically for:

    1. The applicability of the principles of comprehensive Australian general practice for Vocational Training Pathway registrars.
    2. The approval of training sites for the Practice Experience Program – Standard Stream (PEP Standard), and Practice Experience Program – Specialist Stream (PEP SP) for the authorisation of Medicare Provider Numbers,
    3. Determining exam eligibility for commencing Fellowship examinations under the General Practice Experience (GPE) Pathway,
    4. Determining eligibility for Fellowship under the GPE Pathway, and
    5. Assessment of recency and context of practice for participants on the PEP SP.

2.2 Although the primary audience for this document is prospective or current GPE Pathway and PEP SP participants, it is also relevant for:

    1. Training sites interested in accreditation for GP training,
    2. General practices,
    3. Training providers,
    4. Medical Recruitment Agencies,
    5. Rural workforce agencies,
    6. Primary Health Networks,
    7. Department of Health,
    8. Local Health Networks/ Districts,
    9. GP Supervisors Australia, and
    10. GP Registrars Australia.

3. Principles

3.1 Comprehensive Australian general practice:

    1. Prioritises holistic clinical person-centred healthcare,
    2. Is founded on ethical and socially responsible practice,
    3. Addresses the health needs of all people living in Australia in an equitable way, and
    4. founded on ethical and socially responsible practice,
    5. Meets the particular needs of underserved populations including those living in rural and remote regions, and Aboriginal and Torres Strait Islander peoples.

The principles above relate to the guiding principles 1, 2, 3, 8 and 9 of the RACGP educational framework.

3.2 The scope of comprehensive Australian general practice covers the full breadth of age, gender, body system, disease process, or service site. As such, a general practitioner is clinically responsible for:

    1. Illness prevention,
    2. Health promotion,
    3. Early intervention for those at risk,
    4. Management of acute, chronic and complex conditions,
    5. End-of-life care, and
    6. Servicing the entire population.

3.3 General practice primarily occurs in the practice setting and, when required, other facilities and modalities including patients’ homes, via telehealth, health service facilities, outreach clinics, other community facilities and spaces, or at times in hospitals. As such, general practice contexts:

    1. Include continuity of care in primary health, including through an ongoing doctor-patient relationship over time,
    2. Are primarily non-referral based,
    3. Are not limited to a specific discipline,
    4. Ensure medical care in the post is provided and clinically managed by GPs,
    5. Provide comprehensive care, including preventive care, acute and chronic care,
    6. Coordinate care according to patient, family and community needs, and
    7. Deliver patient-centred healthcare. 

4. Minimum time in practice

Time spent working in comprehensive Australian general practice is critical to ensure adequate exposure to a diverse demographic of patients, presentations and processes, continuity of care, and for contextualisation of knowledge.

4.1 Part time general practice

Part time general practice must comprise a 14.5-hour minimum working week, over a minimum of two days per week, of which a minimum of 10.5 hours must be in face-to-face, rostered, patient consultation time undertaking general practice activities.

    1. Work periods must be at least three consecutive hours.
    2. Placements must be a minimum of one month in any one practice to be considered.
    3. Program time calculations based on hours worked are defined by your RACGP-approved program policies.

5. Practice Competencies

An understanding of the competencies required to practice comprehensively is outlined in the RACGP’s Competency profile of the Australian general practitioner at the point of Fellowship. Achievement of these competencies can only be enabled by working in comprehensive general practice.

6. Applicability to Vocational Training Pathway

The Vocational Training Pathway provides comprehensive Australian general practice training. Therefore, registrars on the Vocational Training Pathway must train in accredited or approved training sites.

6.1 For general practice training terms one, two and three, these sites have undertaken a rigorous accreditation process to ensure they provide experience in comprehensive Australian general practice as per the principles outlined in this guidance document.

6.2 At various points during training, registrars will train in contexts that are outside of the principles outlined in this document. The RACGP prospectively approves these contexts on the basis they provide registrars with the opportunity to further develop specific general practice relevant skills. These include:

    1. a 52 week hospital post,
    2. an extended skills post of up to six months,
    3. up to six months in a special training environment (STE), and
    4. training undertaken as part of an advanced rural skills training (ARST) post.

7. Applicability to GPE and Specialist pathways

Participants on the GPE Pathway must apply for assessments of their GPE as per the Assessment of General Practice Experience Policy and participants on the Specialist Pathway must apply for comparability assessment as per the Practice Experience Program – Specialist Stream Comparability Assessment Policy. These assessments are made with reference to the definition of comprehensive Australian general practice as outlined in this guidance document.

7.1 General practice work undertaken overseas may require assessment as part of determination of:

    1. Partial or substantial comparability to RACGP Fellowship for the PEP Specialist Stream, and
    2. RACGP Fellowship exam eligibility and eligibility for Fellowship for the GPE pathway.

Overseas general practice is not deemed 100% comparable as it has not occurred in an Australian context.

7.2 Assessment of GPE and Comparability Assessments

Limited practice scope is determined as per the Assessment of General Practice Experience Policy, General Practice Experience Pathway - Exam Eligibility Policy and the Practice Experience Program Specialist Stream Assessment of Recency Policy as follows:

i. Limited Scope (85% comparable)

  • No cap for GPE Assessment
  • May contribute to a substantially comparable recency assessment for PEP Specialist

ii. Limited scope (75% comparable) 

  • 3.5 year cap for GPE Assessment
  • May contribute to a partially comparable recency assessment for PEP Specialist

iii. Limited scope (50% comparable)

  • 2.5 year cap for GPE Assessment
  • Non comparable for PEP Specialist

Medical practice will be deemed as 85% comparable with no cap on time recognised as part of a general practice experience outcome if the post:

  1. Was undertaken within a comparable overseas health system, and
  2. Covered the full range of demographics and presentations expected to be seen within a fully comparable comprehensive Australian general practice.

Health systems will be compared to the scope of general practice service to the Australian community in the Competency profile of the Australian general practitioner at the point of Fellowship.

Please note, this rating is most applicable for applicants to the Practice Experience Program – Specialist Stream.

 

Medical practice will be deemed as 75% comparable and therefore capped at a maximum of three and a half years full time equivalent experience of time recognised as part of a general practice experience outcome if the post:

  1. Covered the full range of presentations expected to be seen within a fully comparable comprehensive in-clinic Australian general practice but took place in a different health system; or
  2. Took place in an Australian or comparable overseas health system, except with a reduced scope of practice due to a slightly reduced demographic of patients; or 
  3. Took place in an Australian or comparable overseas health system, except with a slightly reduced range of presentations 

 

Medical practice will be deemed as 50% comparable and therefore capped at a maximum of two and a half years full time equivalent experience of time recognised as part of a general practice experience outcome if the post has:

  1. A limited demographic of patients; and/or
  2. A limited range of presentations; and/or 
  3. Limited management options 

Under the Practice Experience Program – Standard Stream, participants can access a Medicare Provider Number to work in an Approved Medical Deputising Service (AMDS).  Provider number approval should not be assumed to indicate that the workplace is necessarily deemed Comprehensive Australian general practice. In general, AMDS are deemed to provide insufficient scope to meet the definition of Comprehensive Australia general practice.

 iv. Non-comparable 

Training experience are otherwise not comparable to Comprehensive Australian general practice. 

 

Please see the FAQs at the bottom of this guidance document for examples of the above.

8. Glossary

8.1  Approved Medical Deputising Services (AMDS)

An AMDS is a service or organisation, approved by the Department of Health, to arrange and facilitate the provision of deputised medical services to patients at the request of their regular general practitioner in the after-hours period when they are not available. Deputising services can be provided at a clinic and/or in the home of a patient.

This definition is taken from the Department of Health’s AMDS Program Guidelines.

 

9. Related Documents

9.1 Assessment of General Practice Experience Policy (clause 5.2)

9.2 Competency profile of the Australian general practitioner at the point of Fellowship(Column 1)

9.3 General Practice Experience Pathway - Exam Eligibility Policy

9.5 General Practice Fellowship Program Placement Guidelines 

9.7 Practice Experience Program – Specialist Stream Comparability Assessment Policy

9.8 Practice Experience Program – Standard Stream Entry Policy (Clause 5.2iii)

9.9 Standards for general practices (5th edition)  (Standard 2)

9.10 Standards for general practice training (3rd edition)(Standard 1.3)

10. FAQs

10.1 What does a 100% comparable post look like?

    1. Dr A works in a large rural town in a long established general practice. They see the full age range from neonates to the elderly. They see slightly more female than male patients (60/40),has an interest in intrapartum care and performs deliveries at the local hospital. They visit the local aged care facility half a day per week and offers home visits..
    2. Dr B works in a capital city inner metropolitan general practice near a university. There are significant numbers of students who may be transient, but approximately 60 percent of their patients are long term patients of the practice and they see the full spectrum of ages and presentations.
    3. Dr C is in a small rural town. They work for three days a week in their town and spends one day per week in a satellite clinic in a smaller town 100km away. The satellite clinic shares staff and medical records with the main practice. The next nearest practice is 200km away and Dr C is responsible for all care for their patients including acute care, chronic disease management and preventative health.

10.2 What does 85% comparable post look like?

85% comparable positions have taken place outside Australia and are limited to positions which provide comprehensive care and are in similar health systems.

    1. Dr D worked in general practice in a large group practice in rural Ireland. They saw patients of all ages and genders, and managed acute care, chronic disease management and preventative care
    2. Dr E trained in a large city practice in a busy UK city. The practice sees patients of all ages and for all presentations. The practice is well supported by referral processes into the local hospital.
    3. Dr F works in a large New Zealand general practice. They have a particular interest in men’s health, works with five female colleagues and sees few female patients (20%). Their female patients are predominantly children. Although the health system is similar to Australia’s, the reduced demographics make the position less comparable
    4. Dr G works in a rural Kenyan general practice. They see the full scope of practice but the health system and disease patterns are different to Australian general practice.
    5. Dr H works in a metropolitan Australian general practice. They have chosen to work mostly in an acute care setting within the practice but for several sessions a week see their long term patients for their ongoing health needs.

10.3 What does 50% comparable post look like?

    1. Dr I is working in a women’s health clinic in an urban general practice with 4 other female doctors. They have been working at the practice full time and sees only female patients. Their services include general health of women which includes preventative care, family planning, antenatal care and cosmetic procedures. They do not see any children or men.
    2. Dr J works as a medical officer for a remote mining site. They have been working part time for the past 6 years. Dr J sees mostly acute presentations and does not see any children. They do provide some preventative care.
    1. Dr K works in a cosmetic medicine and skincare clinic. Although they promote good skin care, preventative measures and healthy living, the scope remains limited to skin health.
    2. Dr L works in a home visiting AMDS.

10.4 What does non comparable post look like?

    1. Dr M is working as a hospital resident in a regional city and has taken weekend shifts at a drive through COVID-19 swabbing clinic. They work 18 hours per week, across the two days. This is assessed as noncomparable as the job is not general practice. There is no continuity, no chronic disease management and no patient assessment. General practitioners have been approached to work in such clinics, but not all work done by general practitioners is necessarily general practice.
    2. Dr N migrated to Australia from Iraq three years ago. They have completed full time hospital resident terms in gastroenterology, psychiatry, orthopaedics, and emergency medicine in a capital city hospital. This is assessed as noncomparable as the jobs are not general practice. The skills they gained will be transferable to general practice but the jobs are not, in themselves, general practice
    3. Dr O works 20 hours per week doing immigration medicals in an Australian capital city. This is assessed as noncomparable as the job is not in general practice. They are not required to take clinical responsibility for the ongoing care of the applicants as they are not the treating doctor

10.5 I’m on the Practice Experience Program - Standard Stream and work in an Afterhours Medical Deputising Service. Why is this not considered comprehensive Australian general practice?

Afterhours Medical Deputising Services (AMDS), by definition, do not meet all requirements of what a Comprehensive Australian general practice context should constitute, as per clause 4 of this guidance document. AMDS do not provide continuing, comprehensive whole person care. Therefore, AMDS may be assessed at 75%, 50% or non-comparable, dependent on the location, context and scope of practice.

 

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