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The Nature, Scope and Content of General Practice

Last updated 31 May 2026 Β· General Practice

πŸ“‹ Key Information Summary

πŸ“‹
  • General practice (GP) is the cornerstone of the Australian healthcare system, providing first-contact, continuous, comprehensive, and coordinated care to individuals and families across the lifespan.
  • The unique features of general practice include generalist scope, person-centred care, continuity of the doctor–patient relationship, community orientation, and whole-person biopsychosocial care.
  • GPs manage approximately 150 million consultations annually in Australia and act as the gateway to specialist, hospital, and allied health services through the referral pathway.
  • Common presenting problems in Australian general practice include upper respiratory tract infections, musculoskeletal complaints, mental health conditions (anxiety, depression), cardiovascular risk checks, skin conditions, and chronic disease reviews.
  • The five most common reasons for GP encounters nationally are hypertension, depression/anxiety, diabetes mellitus, respiratory infections, and general health checks (Medicare Benefits Schedule data).
  • Family medicine recognises the family unit β€” not just the individual β€” as a key determinant of health, illness behaviour, treatment adherence, and recovery outcomes.
  • Understanding family dynamics, genograms, and family life-cycle stages allows GPs to identify systemic patterns of illness, risk, and protective factors that individual consultations may miss.
  • Chronic disease accounts for approximately 87% of the total burden of disease in Australia, with type 2 diabetes, cardiovascular disease, chronic kidney disease, asthma, and COPD being the most prevalent managed in primary care.
  • The Australian Government's Practice Incentives Program (PIP) and Medicare-funded chronic disease management items (MBS 721, 723, 732) support structured, team-based chronic disease management in general practice.
  • Aboriginal and Torres Strait Islander Australians experience a chronic disease burden 2.3 times greater than non-Indigenous Australians; culturally safe, longitudinal GP care is essential to closing the gap.
  • The RACGP defines GP as a discipline requiring broad medical knowledge, procedural skill, and the ability to manage uncertainty, undifferentiated illness, and multimorbidity across all age groups.
  • Preventive care β€” including immunisation (NIP), cancer screening (National Bowel Cancer Screening Program, BreastScreen, National Cervical Screening Program), and cardiovascular risk assessment β€” is a core responsibility of general practice.

Introduction & Scope of General Practice

General practice is the medical specialty that provides continuing, comprehensive healthcare for individuals and families across all ages, genders, diseases, and organ systems. In Australia, general practice sits at the foundation of the healthcare system, coordinating care between community, hospital, specialist, and allied health services. The Royal Australian College of General Practitioners (RACGP) defines general practice as a discipline characterised by its accessibility, its focus on the whole person within the context of family and community, and its commitment to longitudinal, relationship-based care.

Australia has approximately 38,000 registered general practitioners, the majority of whom work in private practice on a fee-for-service model funded predominantly through Medicare. The 16th National Health Survey (ABS, 2022–23) reports that over 88% of Australians visit a GP at least once annually, with an average of 6.3 consultations per person per year. General practice accounts for the largest volume of health service delivery in the country.

The scope of general practice is intentionally broad. Unlike hospital-based specialists, GPs are trained to manage undifferentiated presentations, multi-morbid conditions, and diagnostic uncertainty. They operate across the entire disease spectrum β€” from health promotion and disease prevention, through acute illness management, to palliative and end-of-life care. The content of general practice encompasses acute presentations (infections, injuries, exacerbations of chronic disease), chronic disease management (diabetes, heart failure, COPD, CKD), mental health, women's and men's health, paediatrics, geriatrics, palliative care, procedural work (skin excisions, IUD insertion, joint injections), and preventive health (immunisation, screening, lifestyle counselling).

The Australian healthcare system relies on the GP as the primary gatekeeper: patients require a GP referral to access Medicare-rebatable specialist services, and discharge summaries from hospitals are directed to the patient's nominated GP for ongoing follow-up. This positions the general practitioner as the central coordinator of patient care β€” a role that demands not only clinical expertise but also exceptional communication, systems navigation, and advocacy skills.

πŸ›οΈ
RACGP Definition: General practice is the provision of primary, continuing, comprehensive whole-person medical care to individuals and families in their communities, with a commitment to health equity and evidence-based practice (RACGP, What is General Practice?, 2023).

Unique Features of General Practice

General practice distinguishes itself from other medical specialties through a set of defining characteristics that shape the way GPs think, practise, and relate to patients. These features, articulated by the RACGP and consistent with the World Organization of Family Doctors (WONCA) framework, underpin the identity of the discipline.

First-Contact Accessibility

GPs serve as the first point of contact with the healthcare system for the majority of health concerns. Patients self-refer to general practice without requiring a prior clinician's assessment. This means GPs must be prepared to manage any presentation at any time β€” from benign self-limiting conditions to acute life-threatening emergencies β€” and must possess the clinical acumen to differentiate between the two. Accessibility extends beyond clinical availability to include geographic coverage (urban, rural, remote), affordability (bulk-billing, gap payments), cultural safety, and health literacy considerations.

Continuity of Care

Continuity β€” the ongoing therapeutic relationship between a patient and their GP over time β€” is one of the most studied and valued features of general practice. Research consistently demonstrates that strong continuity of care is associated with reduced emergency department presentations, lower hospital admissions, improved preventive care uptake, better chronic disease outcomes, and lower all-cause mortality (Pereira Gray et al., 2018). In the Australian context, Medicare encourages continuity through the preferred provider model and Practice Incentives that reward longitudinal care.

Comprehensiveness (Generalist Scope)

Unlike organ- or disease-specific specialists, GPs manage the full breadth of medical conditions across all age groups, genders, and organ systems. This generalist mandate requires a breadth of knowledge that is unique among medical specialties. A single morning session may involve neonatal checks, antenatal care, a sports injury, a new diagnosis of type 2 diabetes, a mental health assessment, a skin lesion excision, and end-of-life care planning. The ability to manage diagnostic uncertainty and undifferentiated illness is a hallmark of generalist expertise.

Person-Centred (Whole-Person) Care

General practice adopts the biopsychosocial model of illness, recognising that health and disease are influenced by biological, psychological, social, cultural, and environmental factors. The GP manages not just a diagnosis but the person living with that diagnosis β€” their beliefs, fears, values, family context, socioeconomic circumstances, and life goals. This person-centred approach is fundamental to building therapeutic alliance, supporting shared decision-making, and achieving meaningful health outcomes.

Community Orientation

GPs are community-based clinicians who understand the health needs, demographics, and resources of their local population. This includes awareness of prevalent conditions, culturally specific health risks, socioeconomic determinants, and the availability of local services (allied health, mental health, Aboriginal Community Controlled Health Organisations [ACCHOs], drug and alcohol services). Community orientation also extends to public health responsibilities β€” disease notification, immunisation surveillance, and health promotion activities.

Coordination of Care

The GP acts as the central node in the patient's healthcare network, coordinating input from specialists, allied health professionals, hospital teams, aged care facilities, and community services. This role involves referral, communication, care planning, and β€” critically β€” ensuring that recommendations from multiple providers are synthesised into a coherent, safe management plan for the patient. The Team Care Arrangement (TCA, MBS 723) and GP Management Plan (GPMP, MBS 721) are Medicare-funded tools that formalise this coordination function.

πŸ’‘
Key Concept β€” The "5 C's" of General Practice: The five defining attributes of general practice are: First Contact, Continuity, Comprehensiveness, Coordination, and Community Orientation. These are recognised internationally by WONCA and nationally by the RACGP.
Feature Description Australian Relevance
First Contact No referral required to access GP care Medicare-funded, bulk-billing incentives for concessional patients
Continuity Longitudinal doctor–patient relationship over years/decades My Health Record, shared health summaries, discharge summaries to GP
Comprehensiveness All ages, all conditions, all organ systems RACGP curriculum spans 5 domains of clinical care
Coordination Gatekeeper and coordinator of multidisciplinary care Referral pathways, TCA/GPMP (MBS 721/723), shared care with hospitals
Community Orientation Understanding of local population health needs PHN-aligned health needs assessments, ACCHO partnerships

Common Presenting Problems in General Practice

The spectrum of presenting problems in Australian general practice is extraordinarily broad, reflecting the generalist mandate of the discipline. Data from the Bettering the Evaluation and Care of Health (BEACH) study and its successor, the PANDA (Practice Activity Data Analysis) programme, provide detailed insight into the most common reasons for GP encounters nationally.

Most Common Presentations

The top reasons for GP encounters in Australia consistently include:

  • Hypertension β€” the single most frequently managed chronic condition in general practice, present in approximately 10% of all GP encounters
  • Upper respiratory tract infections (URTIs) β€” including pharyngitis, sinusitis, and the common cold; a leading cause of acute consultations, particularly in paediatric populations
  • Depression and anxiety β€” mental health conditions are managed in approximately 12% of all GP encounters; depression alone accounts for over 4 million GP visits annually
  • Type 2 diabetes mellitus β€” affecting over 1.3 million Australians, with the GP providing ongoing monitoring, titration of medications, complication screening, and lifestyle counselling
  • General check-ups and health assessments β€” including 45–49-year-old health checks (MBS 701), 75+ health assessments (MBS 707), Aboriginal and Torres Strait Islander health checks (MBS 715), and chronic disease reviews
  • Musculoskeletal complaints β€” low back pain, osteoarthritis, soft tissue injuries, and inflammatory arthritis
  • Skin conditions β€” skin cancers (BCC, SCC, melanoma), eczema, psoriasis, acne, and dermatitis; Australia has the highest skin cancer incidence in the world
  • Contraception and reproductive health β€” oral contraceptive prescriptions, IUD insertion/removal, antenatal shared care, menopause management
  • Immunisation β€” delivery of the National Immunisation Program (NIP) schedule, catch-up vaccinations, travel medicine, and influenza/COVID-19 vaccination programmes
  • Preventive health screening β€” National Bowel Cancer Screening Program, BreastScreen Australia, National Cervical Screening Program, cardiovascular risk assessment (CVD risk calculator)

The Undifferentiated Presentation

A hallmark of general practice is the management of undifferentiated illness β€” presentations where the patient's symptoms do not yet point to a clear diagnosis. The GP must apply Bayesian reasoning, time as a diagnostic tool, and the concept of "watchful waiting" while maintaining a low threshold for investigating red-flag symptoms. The prevalence of serious disease is lower in primary care than in hospital settings, meaning that the same symptom (e.g., headache, chest pain, fatigue) carries a very different pre-test probability and requires a different diagnostic approach than it would in an emergency department or specialist clinic.

⚠️
Red-Flag Presentations Requiring Urgent Action: In general practice, certain presentations demand immediate assessment and/or transfer to hospital: suspected acute coronary syndrome, stroke symptoms (FAST assessment), acute anaphylaxis, severe sepsis, meningococcal rash, testicular torsion, ectopic pregnancy with haemodynamic instability, acute psychosis with safety risk, and any presentation suggesting child abuse or neglect (mandatory reporting obligations in all Australian states and territories).
Presenting Problem Approx. % of Encounters Key GP Activities
Hypertension ~10% Monitoring, medication titration, CVD risk assessment
Depression / Anxiety ~12% Mental Health Treatment Plan (MBS 2710–2717), prescribing, referral
URTI ~6% Symptomatic management, antibiotic stewardship
Type 2 Diabetes ~5% HbA1c monitoring, medication review, complication screening
Musculoskeletal ~8% Examination, imaging, physiotherapy referral, pain management
Skin conditions ~7% Dermoscopy, biopsy, excision, dermatology referral
Health checks / screening ~9% MBS 701/707/715, cancer screening, CVD risk

The Family & Family Dynamics

General practice, particularly in the tradition of family medicine, recognises that health and illness cannot be fully understood outside the context of the family. The family is the primary social unit in which health beliefs are formed, illness behaviours are shaped, treatment decisions are made, and recovery or deterioration occurs. Australian general practice, informed by both the biopsychosocial model and systems theory, places the family at the centre of care.

Why the Family Matters in General Practice

Families influence health through multiple pathways:

  • Genetic and biological: Shared hereditary risks (e.g., familial hypercholesterolaemia, BRCA mutations, Lynch syndrome, familial colorectal cancer polyposis) and shared environmental exposures (diet, physical activity, smoking, alcohol)
  • Behavioural and lifestyle: Health behaviours are learned and reinforced within the family unit β€” dietary patterns, physical activity habits, substance use, and attitudes toward healthcare and medication
  • Psychosocial and emotional: Family stress, conflict, domestic violence, separation, grief, and caregiver burden all have direct impacts on physical and mental health
  • Illness behaviour: Families determine when and how a person presents to the GP, what treatments are accepted, and how chronic illness is managed at home
  • Treatment adherence: Family support (or lack thereof) is one of the strongest predictors of medication adherence, appointment attendance, and engagement with lifestyle modification

The Genogram: A Key Tool in Family Medicine

The genogram is a structured family diagram that maps at least three generations of a family, recording health conditions, causes of death, relationship patterns, and psychosocial factors. It is a core tool in general practice for identifying hereditary disease risk, recognising family patterns of illness, and understanding relational dynamics that influence health. For example, a genogram may reveal a strong family history of ischaemic heart disease, prompting earlier cardiovascular risk screening, or may highlight patterns of substance abuse or mental illness that inform the GP's management approach.

Key elements mapped on a genogram include:

  • Standardised symbols for males, females, deceased individuals, and pregnancies (including miscarriage and termination)
  • Relationship lines (marriage, de facto, separation, divorce, conflict)
  • Medical conditions across generations
  • Cause and age of death
  • Substance use, mental health conditions, and domestic violence (denoted by specific notations)

Family Life-Cycle Stages

Understanding where a family sits in its developmental life cycle helps the GP anticipate predictable stressors and health needs. The Duvall family life-cycle model, commonly adapted in family medicine, identifies stages including:

Life-Cycle Stage Key Transitions Common GP Involvement
Couple formation Partnering, merging families Contraception, STI screening, pre-conception counselling
Families with young children (0–5) Parenthood adjustment, sleep deprivation, role change Childhood immunisation, developmental checks, postnatal depression screening
Families with school-age children (6–12) Education, social development Learning difficulties, behavioural concerns, obesity prevention
Families with adolescents (13–18) Independence, identity, risk-taking Mental health, sexual health, substance use, confidentiality
Launching adult children Empty nest, redefining couple relationship Menopause, relationship counselling, career stress
Ageing family / retirement Retirement, grandparenting, loss Chronic disease management, grief, advance care planning
End of life / family dissolution Bereavement, legacy Palliative care, death certification, family bereavement support

Domestic and Family Violence

GPs play a critical role in recognising and responding to domestic and family violence (DFV), which affects approximately 1 in 4 Australian women and 1 in 14 Australian men over their lifetime (ABS Personal Safety Survey, 2021–22). The RACGP's Abuse and Violence General Practice (AVGP) guidelines recommend that GPs maintain a high index of suspicion, ask directly in a safe and confidential environment, provide validation, safety planning, and referral to specialist DFV services (e.g., 1800RESPECT national helpline). DFV is a health issue, not merely a social or legal matter, and is associated with increased rates of depression, anxiety, PTSD, chronic pain, substance misuse, and adverse pregnancy outcomes.

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Mandatory Reporting: All Australian states and territories mandate that health practitioners report suspected child abuse or neglect. In some jurisdictions (e.g., NSW, QLD, VIC), mandatory reporting also extends to elder abuse. GPs must be familiar with their jurisdictional obligations and reporting pathways (e.g., NSW FACS/DCJ, QLD Child Safety, VIC DHHS).

Chronic Disease Management

Chronic disease is the leading cause of illness, disability, and death in Australia, accounting for approximately 87% of the total burden of disease (AIHW, 2023). The Australian Institute of Health and Welfare estimates that 11.6 million Australians (47% of the population) live with at least one chronic condition, and that chronic diseases are responsible for approximately 90% of all deaths annually. General practice is the primary setting for chronic disease prevention, detection, management, and coordination of care.

The Most Common Chronic Diseases Managed in Australian General Practice

Condition Prevalence (Aust.) Key GP Management Activities
Hypertension ~6 million adults BP monitoring, CVD risk assessment, antihypertensive titration
Type 2 Diabetes Mellitus ~1.3 million diagnosed HbA1c monitoring, medication review, annual complication screening (eyes, feet, kidneys)
Cardiovascular Disease ~1.2 million (IHD, stroke, HF) Secondary prevention, lipid management, cardiac rehabilitation liaison
Asthma ~2.7 million Asthma Action Plans, inhaler technique review, spirometry, step-wise therapy
COPD ~600,000 Spirometry, inhaler optimisation, pulmonary rehabilitation referral, oxygen assessment
Chronic Kidney Disease ~1.7 million (stages 1–3) eGFR/ACR monitoring, BP target, SGLT2i, nephrology referral criteria
Osteoarthritis ~2.2 million Exercise prescription, weight management, analgesic review, joint replacement referral
Mental Health (chronic) ~4.3 million (anxiety/depression) GP Mental Health Treatment Plans, medication management, psychological therapy referral

Structured Chronic Disease Management in Australia

The Australian Medicare system provides specific item numbers to support structured, team-based chronic disease management in general practice:

MBS Item Description Key Requirements
MBS 721 GP Management Plan (GPMP) Minimum 60 min consultation; patient with chronic condition; written plan identifying health goals, actions, and services; copy provided to patient
MBS 723 Team Care Arrangement (TCA) Requires existing GPMP; minimum 2 other health professionals identified; coordinated care plan; review within 3 months
MBS 732 Review of GPMP or TCA Minimum 40 min; evaluation of progress toward goals; updated management plan
MBS 10997 Multidisciplinary Case Conference Minimum 3 health professionals; formal meeting to coordinate care; documented outcomes
MBS 701 45–49 Year Old Health Assessment Targeted at patients at risk of chronic disease; preventive care and early detection
MBS 707 75+ Health Assessment Annual; comprehensive geriatric assessment including functional status, falls risk, cognition
MBS 715 Aboriginal and Torres Strait Islander Health Assessment Annual; available to all Aboriginal and Torres Strait Islander people; comprehensive physical, psychological, and social assessment

Principles of Effective Chronic Disease Management

The Wagner Chronic Care Model, widely adopted in Australian general practice, identifies six key elements for effective chronic disease management:

1
Self-Management Support
Empowering patients with knowledge, skills, and confidence to manage their condition daily (e.g., Asthma Action Plans, Diabetes Sick Day Rules, Blood Glucose Self-Monitoring Education).
2
Decision Support
Embedding evidence-based guidelines into clinical practice (e.g., Australian Clinical Guidelines for type 2 diabetes, COPD-X Plan, RACGP Red Book).
3
Clinical Information Systems
Using electronic health records (Best Practice, Medical Director, Zedmed) for recalls, reminders, audit, and population health data extraction.
4
Health System Redesign
Structured care processes including planned visits, recall systems, and chronic disease registers within the practice.
5
Community Resources
Linking patients to community programmes β€” exercise classes (e.g., "Heart Moves"), diabetes education groups, Men's Sheds, ACCHO health programmes.
6
Health System β€” Organisation of Care
Leadership support, team-based care (practice nurses, allied health), and adequate funding (PIP Chronic Disease Incentive).

Multimorbidity

Multimorbidity β€” the co-existence of two or more chronic conditions β€” is the norm rather than the exception in Australian general practice, particularly in patients over 65 years of age (where prevalence exceeds 70%). Managing multimorbidity requires the GP to navigate competing clinical guidelines (each designed for single diseases), prioritise patient-centred goals over disease-specific targets, assess polypharmacy risks (including drug interactions and deprescribing opportunities), and coordinate input from multiple specialists. The RACGP recommends a "whole-person" approach that prioritises treatments most aligned with the patient's values, functional goals, and quality-of-life preferences.

⚠️
Polypharmacy Alert: Patients on β‰₯5 regular medications (polypharmacy) are at significantly increased risk of adverse drug events, falls, cognitive impairment, and hospitalisation. GPs should conduct regular medication reviews (consider MBS 900 β€” Home Medicines Review) and apply deprescribing principles where appropriate (deprescribing.org.au algorithms).

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander Health Considerations in General Practice

Aboriginal and Torres Strait Islander Australians experience a significantly higher burden of chronic disease than non-Indigenous Australians, with a health gap of approximately 8 years in life expectancy and a chronic disease burden 2.3 times greater (AIHW, 2023). General practice has a critical role in both closing this gap and providing culturally safe, responsive care to First Nations peoples.

Key Chronic Disease Disparities

  • Type 2 diabetes: Prevalence 3–4 times higher than non-Indigenous Australians; onset often at younger ages; higher rates of complications (CKD, amputation, retinopathy)
  • Cardiovascular disease: Leading cause of death; rheumatic heart disease remains prevalent in remote communities (particularly NT, QLD, WA)
  • Chronic kidney disease: Rates of end-stage kidney disease are 6–8 times higher; earlier onset; limited access to dialysis in remote areas
  • Respiratory disease: Higher rates of COPD (linked to smoking prevalence), bronchiectasis, and rheumatic heart disease-related pulmonary complications
  • Mental health and social and emotional wellbeing: Higher rates of psychological distress, suicide (especially among young Aboriginal men), and substance use disorders; intergenerational trauma from colonisation, the Stolen Generations, and ongoing systemic racism
  • Otitis media: Chronic suppurative otitis media rates in remote Aboriginal communities are among the highest in the world, contributing to conductive hearing loss and educational disadvantage
  • Rheumatic fever: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are almost exclusively diseases of Aboriginal and Torres Strait Islander Australians in contemporary Australia; secondary prophylaxis with benzathine penicillin G every 28 days is the cornerstone of prevention (RHDAustralia guidelines)

The MBS 715 Health Assessment

The Aboriginal and Torres Strait Islander Health Assessment (MBS Item 715) is available annually to all Aboriginal and Torres Strait Islander people, regardless of age or health status. It is one of the most important tools for early detection and management of chronic disease in primary care. The assessment covers physical health, social and emotional wellbeing, hearing and vision, oral health, lifestyle risk factors, and immunisation status. GPs are encouraged to use the assessment as a gateway to GPMP/TCA (MBS 721/723) where chronic disease management is needed.

Culturally Safe General Practice

Cultural safety goes beyond cultural awareness or cultural sensitivity β€” it requires the GP to reflect on their own cultural identity, biases, and power dynamics, and to create a clinical environment where Aboriginal and Torres Strait Islander patients feel respected, heard, and safe. Key principles include:

  • Acknowledging Country and understanding the significance of land, community, and kinship to health and wellbeing
  • Recognising the impact of intergenerational trauma, grief, and loss on current health behaviours and engagement
  • Allowing adequate time for consultations β€” "yarning" may be a preferred communication style for some patients
  • Involving family and community in health decisions where appropriate
  • Using Aboriginal Health Workers and Aboriginal Health Practitioners as cultural brokers and care navigators within the practice team
  • Displaying welcoming signage, Aboriginal artwork, and the Aboriginal and Torres Strait Islander flags in the practice
  • Partnering with local Aboriginal Community Controlled Health Organisations (ACCHOs) for referral, shared care, and outreach
Remote Access
Specialist and allied health services are limited in remote and very remote communities. GPs in these settings often work with broader scope of practice, supported by the Royal Flying Doctor Service (RFDS), telehealth, and visiting specialist outreach programmes funded by the Australian Government and Primary Health Networks (PHNs).
Health Literacy
Lower average health literacy levels, compounded by English being a second or third language for many patients. The use of plain language, visual aids, interpreter services (Aboriginal Interpreter Service, TIS National), and culturally adapted health resources is essential.
Racism and Mistrust
Historical and ongoing experiences of systemic racism in healthcare (including forced removals, involuntary treatment, and institutional discrimination) contribute to delayed presentation, disengagement, and poor health outcomes. Building trust requires consistent, respectful, and non-judgemental care over time.
Social Determinants
Overcrowded housing, food insecurity, limited access to clean water in some remote communities, lower educational attainment, unemployment, and incarceration rates all significantly impact health outcomes and require a social determinants lens in GP management.
ℹ️
Practical GP Actions for Every Consultation: Ask patients if they identify as Aboriginal or Torres Strait Islander (use the standard ABS question), record this in the patient's health record, offer MBS 715, connect with local ACCHO, use Closing the Gap PBS co-payment measure for eligible patients, and consider a GPMP/TCA for chronic disease management. For rheumatic fever, ensure secondary prophylaxis adherence (28-day benzathine penicillin G IM) per RHDAustralia guidelines.

πŸ“š References

  1. 1. Royal Australian College of General Practitioners (RACGP). What is General Practice? East Melbourne: RACGP; 2023. Available from: www.racgp.org.au
  2. 2. Australian Institute of Health and Welfare (AIHW). Chronic conditions in Australia. Cat. no. PHE 296. Canberra: AIHW; 2023.
  3. 3. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2015–16. General Practice Series No. 40. Sydney: Sydney University Press; 2016.
  4. 4. Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors β€” a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8(6):e021161.
  5. 5. Royal Australian College of General Practitioners (RACGP). Abuse and violence: Working with our patients in general practice (the White Book). 4th ed. East Melbourne: RACGP; 2020.
  6. 6. World Organization of Family Doctors (WONCA). WONCA Europe Definition of General Practice / Family Medicine. Barcelona: WONCA Europe; 2023.
  7. 7. Australian Bureau of Statistics (ABS). National Study of Mental Health and Wellbeing, 2020–22. Canberra: ABS; 2023.
  8. 8. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.
  9. 9. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice (Red Book). 9th ed. East Melbourne: RACGP; 2016 (updated 2023).
  10. 10. RHDAustralia (Rheumatic Heart Disease Australia). 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  11. 11. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
  12. 12. Duvall EM. Marriage and family development. 5th ed. Philadelphia: Lippincott; 1977.
  13. 13. Department of Health and Aged Care (Australian Government). Medicare Benefits Schedule Book. Canberra: Commonwealth of Australia; 2024.
  14. 14. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–834.
  15. 15. Primary Health Network (PHN). Health Needs Assessment: A guide for Primary Health Networks. Canberra: Department of Health; 2023.
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

  1. 1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
  2. 2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
  3. 3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
  4. 4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
  5. 5. Smolen JS, LandewΓ© RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
  6. 6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
  7. 7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  8. 8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
  9. 9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
  10. 10. Pisetsky DS. Antinuclear antibody testing β€” misunderstood or misused? Clin Immunol. 2023;255:109717.
  11. 11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
  12. 12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFΞ± blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
  13. 13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

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