Role

Health advocate and leader

Last updated 13 September 2022

Milestone: Entry

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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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8. Rationally and responsibly use the healthcare system

Know

  • Understand how to help patients navigate the Australian healthcare system and receive and access the care they need. 
  • Understand how the Australian healthcare system is funded, its resource limitations, and the importance of applying a rational approach to referrals and prescribing to ensure that the whole population has access to quality evidence-based care.
  • Describe the components of the Australian healthcare system, including:
    • primary healthcare, including Aboriginal and community-controlled health services
    • GPs, nurses, dentists and allied health professionals in private and community health centres
    • secondary care, provided by non-GP specialists or facilities after referrals have been made by a GP
    • tertiary care, incorporating public and private hospitals and their emergency departments
    • the PBS, which enables subsidised access to some medications
    • the MBS which enables subsidised access to some primary, secondary and tertiary care services, investigations and procedures
    • the supporting governance structure, including the Australian Commission on Safety and Quality in Health Care, the TGA, and state and territory health and insurance ombudsmen.
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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

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

Know

  • Describe the national health priority areas for preventable conditions, including:
    • cardiovascular health
    • cancer control
    • injury prevention
    • mental health
    • diabetes.
  • Describe priority population groups, including:
    • Aboriginal and Torres Strait Islander peoples
    • culturally and linguistically diverse communities
    • refugees and people seeking asylum
    • LGBTIQ+ people
    • elderly people
    • people with disability
    • Australian Defence Force personnel
    • rural and remote communities
    • socioeconomically disadvantaged communities, including people who are unemployed and/or homeless
    • individuals with severe mental health issues
    • individuals in the justice system
    • individuals exposed to family violence
    • children in out-of-home care.
  • Describe determinants of health, including:
    • socioeconomic status
    • literacy and health literacy
    • access to healthcare
    • social justice
    • language
    • education
    • ability to use technology.

Milestone: Foundation

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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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8. Rationally and responsibly use the healthcare system

No additional competencies at this milestone

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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

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

Know

  • Understand public health epidemiology to enable targeted screening and early management of disease states to improve outcomes.
  • Be aware of the key national health priorities. These are the diseases that are the major contributors to mortality and morbidity and the focus for population-based preventive health strategies, including for priority population groups. As of 2012, the Australian Institute of Health and Welfare has defined these as:
    • cardiovascular disease
    • cancer
    • mental health and behavioural conditions
    • diabetes
    • asthma
    • dementia
    • injury
    • obesity
    • osteoporosis
    • arthritis (and musculoskeletal conditions).
  • Use existing programs to identify and manage risks, such as:
    • MBS and PBS measures for Aboriginal and Torres Strait Islander patients (eg the Indigenous Health Practice Incentives Program, health assessments, specific medications and the Closing the Gap PBS Co-payment Measure)
    • other health assessments (eg patients aged 45–49 years, 75+ years)
    • cancer screening (eg nationally funded cervical, bowel and breast cancer programs).

Do

  • Help patients to negotiate obstacles to access the care they need, including opportunistic screening (eg health assessments for Aboriginal and Torres Strait Islander peoples, refugees, people aged 45–49 years or 75+ years).
  • Describe the priority population groups in your local community.
  • Identify and manage modifiable risk factors in vulnerable and priority population groups.

Milestone: Consolidation

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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.

Milestone: Fellowship

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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

Know

  • Be familiar with Australian government-funded health and social service programs that are relevant to the local community, and know the criteria to access these.
  • Establish structures to keep abreast of changes to these to optimise patient access to appropriate services, including:
    • relevant MBS item numbers, including:
      • chronic disease management plans for individuals on low incomes to enable access to allied health services
      • Aboriginal and Torres Strait Islander health assessments
      • mental health plans for individuals on low incomes to enable access to clinical psychologists or counsellors
      • health assessments for individuals aged 45–49 years and 75+ years
      • refugee health assessments
    • Translating and Interpreting Service
    • other mental health programs
    • funded access to treatment, rehabilitation and financial support after a motor vehicle accident from state- and territory-based third-party insurers
    • workers compensation financial support after a work-related injury.

Do

  • Refer patients appropriately to these programs, providing appropriate paperwork and/or referrals according to criteria for eligibility.
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 breadth of factors that increase risk of acute and chronic conditions, and that impact access to healthcare (competency 8.4.2) and resources that support preventive care and healthy lifestyle choices in the local community (competency 9.3.1).
  • Understand the importance of having an ‘equity lens’ to identify where inequity affects access to health services and preventive care (including vaccination and screening) and, more broadly, to health-promoting environments, resources and activities (such as space to exercise, quality nutritious food and a supportive community network).

Do

  • Address stigma and barriers to access when they are identified, and advocate for the rights of individuals: in the community, in own health service, in external health organisations and institutions, with the government and, if appropriate, in the media.
  • Identify issues that may require leadership; for example:
    • improving public awareness of, and reducing stigma about, mental health issues
    • advocating for vulnerable individuals or groups (eg cultural minority groups) to access healthcare (including public health initiatives such as vaccination campaigns) and culturally appropriate health resources
    • improving health literacy
    • improving access to health-promoting environments and activities.

Know

  • Maintain knowledge of:
    • standard and transmission-based precautions (eg outbreak control, including identifying individuals who may have communicable diseases and implementing appropriate procedures to minimise risk of spread)
    • appropriate use of personal protective equipment
    • healthcare-associated infection surveillance, including notifiable diseases.

Do

  • Undertake public health roles relevant to general practice, such as:
    • making notifications regarding STIs to relevant department of health and assisting with contact tracing, once informed consent has been provided
    • implementing vaccination programs with appropriate education (and typically in a team with practice nurse[s]) for communicable diseases (eg active pulmonary tuberculosis)
    • identifying health concerns in the local community (eg related to occupational or environmental risk factors) and managing these through advocacy and professional support
    • staying informed of disease trends and guidelines regarding screening and prevention to help identify vulnerable groups and detect or prevent disease to improve health outcomes.
  • Participate in public health initiatives; for example, health education and promotion campaigns, implementation of vaccination programs and advocacy regarding issues of public health concern.
  • Identify and provide initial safe management of the following conditions to reduce risk of transmission to others, including:
    • notifiable communicable diseases
    • STIs (eg chlamydia, gonorrhoea, syphilis, human papillomavirus [HPV])
    • vector-borne diseases (eg malaria, dengue fever)
    • airborne viruses (eg influenza, COVID-19, tuberculosis)
    • 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, scabies)
    • potential environmental hazards, including those related to climate change (eg water quality, water-borne infections, blood lead levels, respiratory effects of pollution, thunderstorm asthma, heat stroke)
    • occupational hazards (eg Q fever).
      (Note that this is not intended to be an exhaustive list, but rather a guide to common and important-to-know conditions of public health importance.)
  • Appropriately advise parents to notify schools/childcare according to exclusion criteria for common childhood infections; for example, viral diarrhoeal diseases, croup, erythema infectiosum, roseola infantum, hand, foot and mouth disease, pertussis and head lice.

Know

  • Understand the breadth of factors that impact access to healthcare in the local community (competencies 8.3.3 and 9.3.1), both broadly and for specific priority population groups (competency 9.3.2).

Do

  • Identify care provision gaps in the local community (competency 8.3.3).
  • Continue to advocate for individuals to access the care needed (competency 4.3.2).
  • Identify local community agencies that provide care, and the local, state, territory or federal agencies responsible for providing funding.
  • Identify strategies to address care provision gaps through:
    • advocating to external agencies
    • advocating for extending the care provided in own health service, or to find other ways to reduce barriers to access
    • identifying professional development opportunities to improve skills and knowledge to facilitate delivery of care required.
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