Chapter 1: The nature, scope and content of general practice

INTRODUCTION

General practice, synonymous with family practice, remains the indispensable foundation of health service in the community. As the most interesting and challenging of our medical disciplines, it is based on six fundamental principles—primary care, family care, domiciliary care and continuing care, which are all designed to achieve preventive care and personal care.

In the contemporary climate, where medical services are fragmented and there are competing interests, there is a greater need than ever for the medical generalist.

The Royal Australian College of General Practitioners (RACGP) defines general practice and primary care as ‘person-centred, continuing, comprehensive and coordinated whole person care to individual and families in their communities’.¹ The RACGP has defined five domains of general practice:

• communication skills and the doctor–patient relationship

• applied professional knowledge and skills

• population health and the context of general practice

• professional and ethical role

• organisational and legal dimensions

General practice is fundamentally relational, based on the doctor having a deep understanding of the whole person and the ability to manage complex conditions and circumstances. The general practitioner (GP) functions as a physician, counsellor, advocate and agent of change for individuals, families and their communities.²

General practice is not the summation of other specialties practised at a superficial level and we must avoid the temptation to become mere gatekeepers of entry into that system. In the current climate, where medicine is often fragmented, there is a greater than ever need for the generalist. The patient requires a trusted focal point in the often bewildering health service jungle. Who is to do this better than the caring family doctor taking full responsibility for the welfare of the patient and intervening on their behalf?

UNIQUE FEATURES OF GENERAL PRACTICE

Anderson et al.³ emphasise that ‘the unique and important work of the general practitioner is to provide availability and continuity of care, competence in the realm of diagnosis, care of acute and chronic illness, prompt treatment of emergencies and a preventive approach to health care’.

The features that make general practice different from hospital specialist-based medical practices include:

• first contact

• compassion

• diagnostic methodology

• early diagnosis of life-threatening and serious disease

• continuity and availability of care

• personalised care

• care of acute and chronic illness

• domiciliary care

• emergency care (prompt treatment at home or in the community)

• family care

• palliative care (at home)

• preventive care

• scope for health promotion and patient education

• holistic approach to management

• health care coordination

The GP ...