Curriculum for General Practice - The Royal New Zealand College ...

Improving Māori access to primary care will be a key
contribution of general practitioners towards achieving
health equity. The Ministry of Health’s Māori health strategy,
He Korowai Oranga, makes explicit the importance of
supporting the health of Māori not only as individuals, but
as whānau.
Whānau ora has been identified as a preferred framework for
Māori health care by Māori and is also recognised in the sector
for its relevance to primary health care. The implication for
general practice is that general practitioners will contribute to
the generation of self-management knowledge and skills that
whānau take ownership of, such that whānau are empowered
to understand the cause of health problems and at the same
time act to prevent or manage health issues. The transfer
of knowledge and skills to whānau in a way that enables
integration into routine whānau practices and that contribute
to self-management is an important function of whānau oraoriented
general practice care that contributes to health equity
for Māori. 2
Ethical practice
General practitioners will often deal with challenging ethical
issues when helping and caring for their patients. Some
decisions can be very complex and may include end-of-life
issues, consent and confidentiality. The code of ethics for the
medical profession in New Zealand is that of the New Zealand
Medical Association and the College has endorsed this code
for general practice. The code sets out principles of ethical
behaviour for doctors and includes recommendations for
ethical practice. The code enshrines the four moral principles
at the heart of medical ethics: autonomy (the right of patients
to make decisions for themselves), beneficence (doctors
must work towards achieving the best possible outcome for
a patient), non-maleficence (a duty to do no harm) and justice
(equality and fair distribution of resources). It is also critical that
medical practice in New Zealand give effect to the principles
of the Treaty of Waitangi of partnership, participation and
active protection.
Continuous quality improvement
General practice requires a commitment to continuous
quality improvement (CQI) to monitor, evaluate and improve
systems and performance to provide the best possible
health outcomes. The principle of all quality activity is that it
leads to improvement through change. Unless we learn from
evidence or information, it is unlikely that we will know what,
or where, to improve. CQI is a useful approach because it
provides simple, systematic tools and approaches to reflect
and act on the best information available. Understanding
outcomes of care is an essential part of the process because
it informs development of practitioner or practice-based
solutions and activity to improve care for patients.
Person-centred care
Person-centred care explores the patient’s values and
concerns, recognises their need for information and seeks to
understand their world. It involves finding common ground with
the patient about the nature of the issues for which they have
sought help and reaching a mutually agreed management plan.
The consultation enhances the ongoing relationship between
the general practitioner and the patient. In doing so, the general
practitioner balances the needs of individuals and communities
with available resources and enables them to provide
longitudinal continuity of care as determined by the patient.
The generalism of general practice
General practitioners have their own body of knowledge
relevant to their role in primary care. They manage acute,
chronic and complex health problems in individuals, as well as
applying health promotion and disease prevention strategies
appropriate to the communities they work within.
General practitioners are the first point of contact for all new
health needs and problems. The generalism of general practice
enables practitioners to deliver long-term, person-focused care
and meet all the health needs of their patients except those
beyond their scope for which it is impossible or unnecessary
for them to maintain competence in. 3
General practitioners coordinate care with other health
professionals and take an advocacy position on behalf
of individuals and communities when appropriate.
2
Ministry of Health. 2002. He Korowai Oranga – Maori Health Strategy http://www.maorihealth.govt.nz
3
Starfield B. Refocusing the system. N Engl J Med 2008;359:2087-2091
4
Sackett D, Rosenberg W, Muir Gray J, Haynes B, Scott Richardson W. 1996. Evidence Based Medicine: What it is and what it isn’t. British Medical Journal, 312:71-72.
5
Evidence based patient choice Inevitable or Impossible? Edited by Adrian Edwards and Glyn Elwyn. 2001. http://ukcatalogue.oup.com/product/9780192631947.do
www.rnzcgp.org.nz
Curriculum for General Practice
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