Definition of the Discipline and Speciality of General Practice/Family Medicine

Following careful deliberation the group has decided that the European definition of the speciality of general practice does not require modification for the Irish situation.

However modification of the core competencies and characteristics of the discipline of general practice is necessary to reflect important aspects of Irish General Practice.

The European definition of the Discipline and Speciality of General Practice/Family Medicine (2002) states "General Practice is an academic and scientific discipline, and a clinical speciality with its own educational content, research and evidence base and clinical activity, orientated to primary care".

Definitions

The European Definition of the Speciality of General Practice/Family Medicine

"General Practitioners/family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. They care for individuals in the context of their family, their community and their culture, always respecting the autonomy of their patients. They recognise they will also have a professional responsibility to their community. In negotiating management plans with their patients they integrate physical, psychological, social, cultural and existential factors, utilising the knowledge and trust engendered by repeated contacts. General Practitioners/family physicians exercise their professional role by promoting health, preventing disease and providing cure, care, or palliation. This is done either directly or through the services of others according to the health needs and resources available within the community they serve, assisting patients where necessary in accessing these services. They must take the responsibility for developing and maintaining their skills, personal balance and values as a basis for effective and safe health care."

Note: As family doctors are known as general practitioners in some European countries, and family medicine practitioners in others, both terms are used in the definition.

The European definition outlines eleven characteristics of the discipline of general practice/family medicine that in turn can be subdivided into six core competencies. For the purpose of clarity the curriculum committee has used the following definitions to clarify what is meant by each of these terms

• A characteristic can be defined as a distinctive ability which every GP should master.
• Core means essential to the discipline.
• Competence relates to specific tasks that a GP should be able to perform.

Competencies

The European definition of the discipline of general practice has six core competencies:

• Primary care management
• Person centred care
• Specific problem solving skills
• Comprehensive approach
• Community orientation
• Holistic modelling

Characteristics

The eleven characteristics of the discipline of general practice are grouped into the six core competency areas (which have been modified by the ICGP committee):

Primary Care Management

1. The ability to manage primary and continuing contact with patients adhering to the principles of confidentiality and maintaining accurate patient records.

2. (a) The ability to co-ordinate care with other professionals in primary care and specialists leading to effective and appropriate care provision, taking the advocacy position with the patient when needed. The ability to participate in teamwork and delegate tasks, where appropriate, in the general practice setting.
(b) The ability to manage change exploring its positive potential.

Person-Centred Care

3. The ability to adopt a person centred approach, dealing with patients and problems with respect and dignity and developing a relationship of trust. Protection of marginalised patients should be a priority.

4. The ability to develop and use the general practice consultation to produce an effective doctor patient relationship. The ability to share with the patient the decision making process and responsibility for their health.

5. The ability to provide longitudinal continuity of care as determined by the needs of the patient while striving to maintain a person centred approach which may become more difficult in the context of changing practice models.

Specific Problem Solving Skills

6. The ability to utilise a specific decision making process informed by the clinical picture and the prevalence and incidence of illness in the community.

7. The ability to diagnose and manage conditions some of which may present early in an undifferentiated way, to intervene urgently when necessary, to tolerate uncertainty and unpredictable developments and to know when appropriate to cease investigation, while continuing to provide care.

Comprehensive Approach

8. The ability to manage acute, chronic and rehabilitative health problems simultaneously in the same individual. GPs while maintaining their generalist skills may also wish to develop special skills.

9. (a) The ability to promote health and well being by applying health promotion and disease prevention strategies appropriately. The ability to recognise that GPs have a responsibility not to medicalise normality.
(b) The ability to value the importance of their listening and supportive role.

Community Orientation

10. (a) The ability to reconcile the health needs of individual patients and the health needs of the community in which they live, balanced with available resources, recognising the responsibility to maintain their own skills.
(b) The ability to participate in combined care taking an appropriate part with secondary and tertiary care.

Holistic Modelling

11. (a) The ability to use a bio-psycho-social model taking into account cultural and existential dimensions. The ability to recognise the role of social, cultural, ethical, religious and family background in the determination of health.
(b) The ability to maintain and nurture ones own physical and mental well being which leads to better patient care (recognising limitations and professional boundaries and the need to seek help when appropriate).

Implementation

Having defined the characteristics and core competencies of the discipline the European definition outlines the importance of implementing them in these three important areas:

• Clinical tasks.
• Communication with patients.
• Practice Management.

Finally, three fundamental background features need to be taken into account for successful application of the content of the definition:

• Context: The context of the person, the family, the community and their culture in which the definition is applied. In the Irish situation the context of inter-current changes in demographics and manpower needs is particularly relevant.
• Attitudes: General Practitioners attitudes based on their professional capabilities, values and ethics.
• Scientific Evidence: General Practitioners need to adopt a critical and research based approach to practice and maintain this through continuing learning and quality improvement.

Therefore, the six core competencies, the three implementation areas and the three fundamental background areas must all be incorporated to define the discipline of general practice.