WHAT IS SPECIALIST GENERAL PRACTICE?
General practice in Australia has been a specialty since 1996. Since then all doctors wanting to work in general practice have had to undertake specialist training and complete a fellowship (specialist qualification in medicine). In other words a doctor could not just set up in general practice after one or two years as a junior doctor; since 1996 a doctor has to undertake a rigorous training program in general practice and pass a difficult set of standardized validated assessment examinations. Then the doctor is awarded a fellowship in general practice (Fellowship of the Royal Australian College of General Practitioners or FRACGP). This qualification is a specialist medical qualification and is recognized by the Medical Council of Australia as such.
DEFINITION OF SPECIALIST GENERAL PRACTICE
Specialist general practice is whole person care, characterised by the provision of person centered, continuing and comprehensive medical care to individuals and families in their communities. As a relationship based discipline, general practice seeks to build health, wellbeing and resilience through a continuing patient‐doctor relationship of trust, clinical acumen, the application of best available evidence in the unique context of each consultation, and planned coordination of clinical teamwork, resources and services. The patient’s needs, values and desired health outcomes always remain central to the general practitioner’s evaluation and management processes.
GENERAL PRACTICE IS DEFINED BY ITS CORE CHARACTERISTICS:
Whole person care
an understanding of the interplay between bio/psycho/social contributors to health leads to a deep understanding of the whole person, and the ability to manage complex conditions and circumstances. The general practitioner functions not just as physician and counselor, but as an agent of change for individuals and families.
general practitioners understand that health, illness and disease are ultimately personal experiences, and that their principle role is to relieve personal disease in all its forms, and in the manner best suited to each individual at that moment in time.
Continuity of care
long‐term relationships build mutual knowledge, understanding, experience and trust: all essential elements in a therapeutic relationship, which generates the potential for healing, increased resilience, empowerment and beneficial change.
general practice is not limited by age, gender, body system, disease process or service site. The scope of practice is forever challenging its practitioners, spanning prevention, health promotion, early intervention for those at risk, and the management of acute, chronic and complex conditions – whether in the home, practice, health service, outreach clinic, hospital or community.
Diagnostic and therapeutic skill
the general practitioner’s high level diagnostic and therapeutic skills – applied in the context of person centered, continuing relationship, is known to deliver safe, high quality, cost effective care that is highly valued by patients.
A command of complexity and uncertainty
general practitioners are comfortable with uncertainty, and skilled in managing complexity. They are able to utilise best practice evidence in the light of individual patient circumstances, and engage patients, parents and families in understanding, planning and better managing their own health according to their individual capacities.
Coordinated clinical teamwork
general practitioners work in close and respectful relationships to deliver integrated patient care: leading, supporting and coordinating their flexibly configured clinical teams; contributing appropriately to external clinical teams, and collaborating with a diversity of community based professionals – according to individual patient or family needs and circumstances.
THE CHARACTERISTICS OF QUALITY GENERAL PRACTICE RESULT IN:
A commitment to quality and safety
quality care requires continuing quality improvement processes, which underpin delivery of care at every level; from individual practitioner and clinical team through to local and national levels. Also critical is the capacity to assess professional capabilities, acquire new skills and expand existing skills over a professional lifetime in response to constantly changing clinical and community contexts.
Accessible and appropriate care
effective general practice is accessible practice, requiring a receptive, patient‐focused culture by all involved in providing care. Central to the delivery of accessible, acceptable and appropriate care are: ongoing engagement with patients, systematic identification of patient and community needs, closely linked planning of quality systems and service configurations (including after hours and outreach services), utilisation of best available technology and engagement in community development.
An understanding of the socio‐economic determinants of health
appreciation of the importance of environmental constraints on patients’ health and the essential contribution made by other health professionals, other sectors and the community, leads to wide engagement, collaboration and community leadership, influencing local environments to benefit individuals, families and community.
A central role in the primary health care system
rigorous scientific medical training, the resulting clinical acumen, and the ability to appropriately apply the evidence in community based settings, necessarily places general practice at the center of an effective primary health care system. These same qualities when combined with the discipline’s holistic, relationship based philosophy and broad generalist practice, distinguish the discipline in large measure from other medical disciplines.
High professional, ethical and clinical standards
professional standards provide general practitioners with the essential framework for decision making in a complex environment where the ethical tensions between providing best possible care for individual patients, the cost effective utilisation of limited public resources and achieving equity for the disadvantaged and at risk, must constantly be considered and resolved.
Continuing evolution of the discipline
general practitioners’ contribution to the evolution of their discipline according to individual interests, skills and circumstances through diverse involvements in teaching, mentorship, community based research and local health service planning and service development, with all elements understood as being integral to clinical practice, quality care and the continuation of a high quality workforce.
General practice is proud to have delivered accessible, people‐centered, continuing and comprehensive care to the Australian community for over five decades. People‐centered healthcare has delivered overwhelming evidence of significant improvements in health outcomes, equity and cost effectiveness around the globe. The challenge is to further enhance care by expanding and integrating the specific skills of all involved healthcare providers to meet people’s changing needs, seamlessly and safely, over the whole of the healthcare journey within their local communities.