General practice

What is general practice?

General practice is a clinical specialty orientated to primary health care. It is a first-level service for improving, maintaining, restoring and coordinating people's health. General practice is focused on patient's needs and enhancing the networks among local communities, other health providers and social services.

General practice has a specific responsibility for health in the community, and deals with health problems in their physical, psychological, spiritual, social and cultural dimensions.

Essentially, general practice:

• is personal, family and community oriented care that continues over time and is anticipatory as well as responsive
• is normally the point of first medical contact within the health care system, dealing with all health problems regardless of the age, gender, culture or any other characteristic of the person concerned
• makes efficient use of health care resources through the coordination of care, working with other professionals in the primary health care setting, managing the interface with other specialties, and taking an advocacy role for the patient when needed
• develops a person-centred approach, oriented to the individual, as well an approach that is responsive to the needs of their family/whānau and their community
• has a unique consultation process that establishes a relationship over time, through effective communication between clinician and patient
• is responsible for the provision of longitudinal continuity of care as determined by the needs of the patient
• has a specific decision-making process determined by the prevalence and incidence of illness in the community
• diagnoses and manages both acute and chronic health problems of individual patients
• diagnoses and manages illness which presents in an undifferentiated way at an early stage in its development, which may require urgent intervention
• promotes health and well-being through appropriate and effective intervention.

General practice in New Zealand functions as a team. Together with general practitioners, practice nurses play an important role in providing health advice and services such as immunisation, screening, diet, diabetes and asthma care. Other staff such as psychologists, social workers and physiotherapists may work in, or be associated with, practices.

Most general practices are part of a PHO and receive funding based on their enrolled patient population. Those practices that provide care for populations with a high percentage of Maori, Pacific and lower socio-economic groups may receive increased funding.

Patients are usually required to provide a co-payment, although in different areas there will be a range of free services depending on local contracts. In some instances this can include mental health services.

The role of general practice in the delivery of primary mental health care

As the first point of contact with the health system for the majority of people, providing services to patients with mental health issues has been a core component of general practice. This is highlighted by studies that show that whilst only 3-8% of those accessing general practice sight mental health problems as the main reason for their consultation, just over a third (36%) of all attendees had one or more of the three most commonly presenting mental health disorders - anxiety, depression or substance use disorder and approximately half have some level of psychological distress¹. With the majority (50-70%) of these individuals managed solely by general practice, it is evident that general practice continues to play a crucial role in the delivery of mental health services in New Zealand.

More information about general practice can be found on the Royal New Zealand College of General Practitioners website - www.rnzcgp.org.nz.

Source

• Royal Australian and New Zealand College of Psychiatry online orientation programme for overseas trained psychiatrists practicing in New Zealand.

Reference

1. Findings from the Mental Health in General Practice (MaGPIe) study as cited in: Dowell, T., Garrett, S., Collings, S., McBain, L., McKinlay, E. & Stanley, J. 2007. Primary Mental Health Initiatives: Interim Report. Wellington: School Of Medicine and Health Sciences, University of Otago. Wellington.