The RACGP has updated its definition of a general practice to ensure practices providing ‘comprehensive, patient-centred, whole-person and continuous care’ are eligible for accreditation against the Standards.
The definition is used to identify services eligible to be assessed as a general practice by an accreditation agency approved under the Australian Commission on Quality and Safety in Healthcare’s National General Practice Accreditation Scheme.
Newly included non-traditional general practices might include mobile services such as outreach disability services or those servicing a specific patient cohort within facilities, including residential aged care facilities and disability homes.
The college said that broadening the definition of a general practice for the purpose of accreditation aimed to achieve greater equity for GPs.
The new definition maintains its function of identifying practices which can be assessed for general practice accreditation, while extending access to models of general practice previously excluded from accreditation.
In line with the changes, for a practice or health service to seek accreditation:
- it must provide comprehensive, patient-centred, whole-person and continuous care; and
- its services must be predominantly* of a general practice nature.
- more than 50% of the practice’s general practitioners’ clinical time and more than 50% of services for which Medicare benefits are claimed or could be claimed (from that practice) are in general practice.
The general practice, once acknowledged as meeting the definition, must still meet all mandatory indicators in the Standards to be accredited.
There will be some services that are eligible to be accredited against the Standards but may not be appropriate as training practice locations or eligible for entry into a training program.
Services that provide limited or non-continuous care are not eligible for accreditation, including:
- telehealth-only services (including on-demand telehealth services), where continuous care may be provided but scope of care provided is limited (i.e. physical assessment is not possible)
- services that focus on a specific body system or disease process (such as skin cancer or mental health clinics), where scope of care provided is limited.
- services that are not GP-led; that is, those that do not provide predominantly general practice services as per the description of predominantly within the definition (e.g. nurse-led services).
The definition noted that a women’s health service that offers the full scope of generalist services to women would be eligible for accreditation under the new definition; however, if that clinic only offered specific services to its patients (such as reproductive health), it would be ineligible for accreditation.
“For example, the service should be able to provide any general practice care its patient population might reasonably expect to receive from a GP, such as vaccination services,” the report explained.
One aspect of the definition that raised questions was the inclusion of counselling under ‘whole-person care,’ as historically the RACGP’s own literature has flagged psychological support as an area for improvement in terms of training and provision.
The definition’s Interpretive Guide states that “A general practitioner (GP) functions as a physician, counsellor, advocate, and agent of change for individuals, families and their communities,” yet there is a significant gap in the literature which needs to be filled.
For example, four diverse general practice studies of cognitive behavioural therapy for depressed patients have reported that it was:
- superior to drug treatment
- temporarily better than usual GP care but no better at three month follow up
- better than usual GP care at four months but no better at 12 month follow up, and
- no better than usual GP care.
According to the RACGP’s own research, while GPs have been shown to be the first professional contact in over 70% of cases of depression in Australia, GPs, especially those without mental health training, may perceive insufficient knowledge as a barrier to management; and the college asserted that training remained the fundamental strategy to improve GPs’ skills, motivation, and participation in mental healthcare.
Another aspect of the definition raises questions regarding the government’s push for multi-disciplinary, GP-led care teams — the exclusion of nurse-led service teams, who have traditionally fulfilled most aged care health support roles, with the assistance of a GP who may or may not be able to attend on site.
Back in 2021, the AMA and Australian Nursing and Midwifery Federation (ANMF) were calling for the Morrison Government to implement the Royal Commission’s Final Report recommendations to address the critical nursing shortage in Aged Care: minimum qualified staff time in nursing homes should be 200 minutes per resident per day – about three hours and 20 minutes – with at least 40 minutes provided by a registered nurse.
It also recommended the minimum staff time standard require at least one RN on the morning and afternoon shifts from 1 July 2022, but has delayed the introduction of 24-hour RN staffing until July 2024. The recommended five-star model was 264 minutes of care or more – four hours and 24 minutes – with 63 or more minutes with a RN.
At the time, the Federal Secretary of the ANMF Annie Butler noted that “once the visiting GP departs the nursing home, RNs are the only qualified aged care staff able to provide appropriate clinical care to patients.”
It is unlear how the new definition will impact the level of care provided to patients living in aged care residential facilities.