2014 Curriculum For General Practice

Curriculum
for General
Practice
www.rnzcgp.org.nz
Curriculum for General Practice
What’s inside:
Mihi 01
Foreword 02
Acknowledgements 03
Part 1 – Curriculum development 04
Part 2 – General practice in New Zealand 07
Part 3 – Curriculum framework 08
Part 4 – Delivering the curriculum 11
Part 5 – Curriculum domains 13
Domain 1 – Communication 14
Domain 2 – Clinical Expertise 16
Domain 3 – Professionalism 18
Domain 4 – Scholarship 20
Domain 5 – Context of General Practice 22
Domain 6 – Management 24
Part 6 – Curriculum statements 26
Curriculum statements 27
02 Curriculum for General Practice

Mihi
E nga- mana, e nga- reo, e nga- karangatanga maha

mai nga- to-pito o te motu, te-na- koutou katoa. Te-na-
koutou i o- ta-tou tini mate kua whetu-rangitia. No- reira,
nga- mate, haere. He kaupapa tino whakahirahira te-
nei mo- ta-tou nga- rata a--wha-nau o Aotearoa, tuakana
teina ra-nei, ahakoa no- whea, ahakoa ko wai, ahakoa
ko te-hea tikanga. Mehemea ka whakapakari nga- pu-
kenga me te ma-tauranga hoki ka pua-wai te hua hei
oranga mo- ta-tou te tangata, a-, ka whakamana te
kaupapa e whai ake nei. Heoi ano- e te iti, e te rahi,
te-na- ta-tou huri noa.
Greetings to all of us, and to those who have

passed on we greet and acknowledge you also.
The new curriculum is very important for all general
practitioners to ensure we have the appropriate skills
and knowledge base to provide optimum health care
to patients in our diverse communities. Once again,
greetings and best wishes.
www.rnzcgp.org.nz Curriculum for General Practice 01

Foreword
Foreword
The Royal New Zealand College of General

Practitioners’ Curriculum for General Practice
has been updated and expanded to ensure our
training programme equips general practitioners
to practise successfully in New Zealand’s rapidly
evolving health environment.
Since 2010, the College has been working in partnership The kaupapa/spirit of this document reflects the cultural
with Health Workforce New Zealand (HWNZ) and the Medical diversity of New Zealand society and the need for general
Council (MCNZ) to review how general practitioners are practitioners to work with patients, family/wha-nau and
trained. We have jointly identified the requirement for general general practice teams to achieve good health outcomes.
practitioners to provide more complex care and the need for
stronger relationships to be formed between primary and On behalf of the College I want to thank the Curriculum
secondary services. Review Committee which has created and developed an
outcomes-based curriculum that meets these needs and
The curriculum was considerably enhanced in 2012, better reflects the broad scope of general practice.
building on the significant work completed on the curriculum
since 2008 and expanding existing syllabuses to meet the
changing needs of the New Zealand population and our
primary care environment. Minor updates have been made in
2014 to ensure that the curriculum remains current, coherent
and relevant to general practice.
It is a dynamic, working document designed not only Tim Malloy

for those who are training in general practice but also President
for experienced general practitioners maintaining their
competencies.
The RNZCGP Curriculum for General Practice 2012

(2014 edition) is divided into six domains and 31 curriculum
statements and outlines the competencies related to the
wide range of patient populations and processes in general
practice in New Zealand.

Acknowledgements
Acknowledgements
A working group known as the Curriculum Review The Curriculum Review Committee thanks all the College
Committee developed this revised and enhanced members who have responded to the consultation process
curriculum. The members of this group were: through the following groups:
• Dr Samantha Murton – Curriculum Development Lead • GPEP medical educators

- National Clinical Leader GPEP1
• GPEP teachers
• Dr Liza Lack – National Clinical Leader GPEP2
• College Faculties
• Dr Kerryn Lum – GPEP Medical Educator
• Te Akorangi a Maui (Ma-ori Faculty)
• Dr Struan Clark – PGGP, GPEP Medical Educator
• University Departments of General Practice
• Dr Peter Fleischl – RNZCGP Censor (Otago, Christchurch, Auckland, Wellington)
• Dr Rawiri Keenan – Registrar Representative • Primex examiners
• Sue Domanski – Education Advisor Training & Evaluation • Fellowship assessors
• Rhett Emery – Manager Vocational Training • College censors
Contributing members The Curriculum Review Committee is also grateful to the

many individuals from the wider medical community who
• Dr Ralph Wiles – Censor in Chief made specific comment during the review process.
Emeritus Professor Dr Campbell Murdoch
– GPEP Medical Educator
• Dr Keri Ratima – Tumu-aki Ma-ori

Part 1 - Curriculum development
Part 1
Curriculum development
The overall goal of The Royal New Zealand
College of General Practitioners (the College)
is to improve the health of all New Zealanders
through high-quality general practice care.
The College recognises the status of the
Treaty of Waitangi and accepts its principles of
partnership, participation and active protection.
The College sets standards and provides vocational A review of the curriculum started in 2005 with the
education to postgraduate doctors who wish to train in objectives of:
general practice. It delivers a rural general practice rotation
for junior doctors and a 36-month training programme for • developing a coherent, accessible framework for vertical
doctors who wish to gain Fellowship of the College and integration for the College’s vocational education pathway
eligibility to apply for vocational registration with the Medical
Council of New Zealand. • reviewing the curriculum domains for their relevance to
current general practice
The College also provides the framework for maintaining
• defining core competencies and standards for general
competencies in the vocational scope of general practice
practice education.
and helps prepare the future workforce for the changing
nature of health care in New Zealand. The pathway working party completed their work on the new
curriculum in late 2006. The document was refined throughout
In 1998 the College published a curriculum for general 2007 and 2008 after further consultation and piloting.
practice education in New Zealand. This curriculum was
based on the three key concepts of person-centred From 2009 onward the training programme became more
care, the generalism of general practice and evidence- centralised and all regions were supported and guided
based medicine. It covered the period from graduation to by an expanded syllabus in the form of Training Scaffolds
vocational registration. ensuring consistency in the delivery of education. Thirty-six
Training Scaffolds were developed to integrate seminar and
In 2000 a syllabus was developed for the Stage 1 General in-practice teaching. Using the domains of practice they
Practice Education Programme (GPEP) and was revised supported the seminar days and included reading resources,
in 2005. In 2002 a prescription was developed for the scholarship activities, online assessment, in-practice
postgraduate rural general practice education programme. teaching and skills training. The Training Scaffolds helped
registrars focus on what to learn and allowed space for
repetition of newly acquired skills in seminars and teaching
practices so that the learning could be consolidated.

Overarching Curriculum
Curriculum Statements
Syllabus Primex Blueprint

Maintenance
Training Scaffolds of Professional
Standards
Learning Environment
In May 2010 the College signed a memorandum of The curriculum statements are indicative of what is current
understanding with Health Workforce New Zealand and the and offer a vision for the future. They provide a base from
Medical Council of New Zealand to review general practice which new concepts and structures will grow. The three key
training and implement changes to the current programme concepts of general practice have been applied – person-
to meet emerging health workforce requirements. The centeredness, generalism and evidence.
three partners recognised that how we trained general
practitioners needed to evolve to better meet the needs of
New Zealand’s aging population, the requirement for more
complex care to be provided by general practitioners and
the need for stronger relationships to be formed between
primary and secondary services.
Thirty-one curriculum statements have been developed The

to reflect the scope of general practice in New Zealand. generalism of
A number of themes are reflected throughout the general
curriculum and include: practice
• Ma-ori health
Syllabus &
• rural health Curriculum
• disability
Evidence-based Person-
• prescribing practice centered
care
• multiculturalism
• integrative health care
• leadership
• education.

Part 1 - Curriculum development
The knowledge, skills and values identified in each of

the curriculum statements are relevant to all aspects of
the curriculum framework and general practitioners are
encouraged to integrate key critical thinking, critical appraisal
and research skills with their role as professional practitioners.
They represent the vocational pathway to Fellowship of the

College and vocational registration with the Medical Council
of New Zealand. They also provide guidance for experienced
general practitioners maintaining their professional
standards. Each curriculum statement has an associated
syllabus which is a practical resource outlining the training
activities to develop the skills, knowledge and attitudes
required for those working in general practice.
The syllabus identifies the learning outcomes to be achieved

in a particular area and the broad content to be covered over
the training programme. Learning will take place in a flexible
manner and not necessarily in any specific order as patients,
who provide our most consistent learning, do not turn up in
relation to our learning needs of the day. The syllabus has
a learning structure that presents the core issues of general
practice in a range of clinical, ethical, legal and sociocultural
contexts throughout the training programme.
Ongoing curriculum refinement by the College will be a

continuous process through the development of syllabuses,
learning programmes and assessments for vocational education.

Part 2 – General practice in New Zealand
Part 2
General practice in New Zealand
General practice is gazetted by the Medical Council of • has a specific decision-making process determined by
New Zealand as: the needs of the patient
an academic and scientific discipline with its own • diagnoses and manages simultaneously both acute
philosophy, educational content, research, evidence base and chronic health problems of individual patients
and clinical activity, and is a clinical specialty orientated
• diagnoses and manages illness that presents in an
to primary care. It is personal, family and community
undifferentiated way at an early stage of its development,
oriented comprehensive primary care that includes
which may require urgent intervention
diagnosis, is continuous over time, and is anticipatory
as well as responsive. • promotes health and wellbeing through appropriate and
effective intervention
The College expands this definition as follows. • has a specific responsibility for health in the community
General practice is an academic and scientific discipline with • deals with health problems in the physical, psychological,
its own educational content, research, evidence base and social and cultural dimensions.
clinical activity. It is a clinical specialty oriented to primary
health care. It is a first-level service that requires improving,
maintaining, restoring and coordinating people’s health. It
focuses on patients’ need and enhancing the network among
local communities, other health and non-health agencies.
General practice:
• is personal, family/wha-nau and community oriented,

comprehensive primary care that continues over time, is
anticipatory as well as responsive, and is not limited by the
age, gender, ethnicity, religion or social circumstances of
the patient nor by their physical or mental states
• is normally the first point of contact within the health system,

providing open and unlimited access to its users, 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

coordination of care, working with other health professionals
in the primary health setting, managing the interface with
other specialties, and providing an advocacy role for the
patient when needed
• develops a person-centred approach, oriented to the

individual, as well as an approach that is responsive to
the needs of the family/wha-nau 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

Part 3 – Curriculum framework
Part 3
Curriculum framework
The curriculum defines the knowledge,
skills and attitudes required for general
practice from postgraduate years to beyond
Fellowship. It guides and supports registrars
to demonstrate and achieve the required
competencies and acts as a resource for
general practice educators to help them
facilitate registrars’ learning. It enables
assessors to develop valid and reliable
assessments of the required competencies.
The curriculum also guides the continuing professional Culturally competent practice
development of vocationally registered general practitioners to The principles of culturally competent practice extend
ensure their knowledge, skills and attitudes continue to reflect to all cultural groups.1 Cultural competence requires an
contemporary practice. understanding of one’s own cultural background and how this
affects the doctor–patient relationship.
Key principles and concepts underpinning the curriculum The College recognises the importance of effective
communication with Ma-ori patients to establish trust and
The goal of The Royal New Zealand College of provide the best health care. There is a need to understand
General Practitioners the importance of wha-nau, hapu, iwi and the effect that social
The overall goal of the College is to improve the health of all structures have on Ma-ori health.
New Zealanders through high-quality general practice care.
Equity and health disparities
Treaty of Waitangi As a principle, ‘equity and health disparities’ is concerned with
The College recognises the status of the Treaty of Waitangi and eliminating avoidable, unfair and unjust systematic disparities in
accepts its principles of partnership, participation and active health outcomes. The concept of health equity acknowledges
protection derived from the Treaty, as the guide to relationships that different types and levels of resources may be required for
between Ma-ori and the Crown. equitable health outcomes to be achieved for different groups.
The College is committed to understanding the determinants of

health and reducing Ma-ori and non-Ma-ori disparities in health
outcomes, and ensuring equitable access to health services for
all New Zealanders.
1
Drs Tony Ruakere, Mason Durie, Iain Hague and Irihapeti Ramsden

Improving Ma-ori access to primary care will be a key Continuous quality improvement
contribution of general practitioners towards achieving General practice requires a commitment to continuous
health equity. The College has developed a Ma-ori health quality improvement (CQI) to monitor, evaluate and improve
strategy, He Ihu Waka, He Ihu Whenua, to promote the systems and performance to provide the best possible
achievement of health equity for Ma-ori, and to recognise the health outcomes. The principle of all quality activity is that it
specific rights that Ma-ori are entitled to deriving from their leads to improvement through change. Unless we learn from
status as the indigenous population of New Zealand. evidence or information, it is unlikely that we will know what,
or where, to improve. CQI is a useful approach because it
The Ministry of Health’s Ma-ori health strategy, provides simple, systematic tools and approaches to reflect
He Korowai Oranga, makes explicit the importance of and act on the best information available. Understanding
supporting the health of Ma-ori not only as individuals, but outcomes of care is an essential part of the process because
as wha-nau. Wha-nau ora has been identified as a preferred it informs development of practitioner or practice-based
framework for Ma-ori health care by Ma-ori and is also solutions and activity to improve care for patients.
recognised in the sector for its relevance to primary health care.
The implication for general practice is that general practitioners Person-centred care
will contribute to the generation of self-management knowledge Person-centred care explores the patient’s values and
and skills that wha-nau take ownership of, such that wha-nau concerns, recognises their need for information and seeks to
are empowered to understand the cause of health problems understand their world. It involves finding common ground with
and at the same time act to prevent or manage health issues. the patient about the nature of the issues for which they have
The transfer of knowledge and skills to wha-nau in a way that sought help and reaching a mutually agreed management plan.
enables integration into routine wha-nau practices and that
contribute to self-management is an important function of The consultation enhances the ongoing relationship between
wha-nau ora-oriented general practice care that contributes to the general practitioner and the patient. In doing so, the general
health equity for Ma-ori.2 practitioner balances the needs of individuals and communities
with available resources and enables them to provide
Ethical practice longitudinal continuity of care as determined by the patient.
General practitioners will often deal with challenging ethical
issues when helping and caring for their patients. Some The generalism of general practice
decisions can be very complex and may include end-of-life General practitioners have their own body of knowledge
issues, consent and confidentiality. The code of ethics for the relevant to their role in primary care. They manage acute,
medical profession in New Zealand is that of the New Zealand chronic and complex health problems in individuals, as well as
Medical Association and the College has endorsed this code applying health promotion and disease prevention strategies
for general practice. The code sets out principles of ethical appropriate to the communities they work within.
behaviour for doctors and includes recommendations for
General practitioners are the first point of contact for all
ethical practice. The code enshrines the four moral principles
new health needs and problems. The generalism of general
at the heart of medical ethics: autonomy (the right of patients
practice enables practitioners to deliver long-term, person-
to make decisions for themselves), beneficence (doctors
focused care and meet all the health needs of their patients
must work towards achieving the best possible outcome for
except those beyond their scope for which it is impossible or
a patient), non-maleficence (a duty to do no harm) and justice
unnecessary for them to maintain competence in.3
(equality and fair distribution of resources). It is also critical that
medical practice in New Zealand give effect to the principles General practitioners coordinate care with other health
of the Treaty of Waitangi of partnership, participation and professionals and take an advocacy position on behalf
active protection. 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

Part 3 – Curriculum framework
Evidence-based medical practice

Evidence-based medicine is the conscientious, explicit and
judicious use of current best evidence in making decisions
about the care of individual patients. The practice of evidence-
based medicine means integrating clinical expertise – the
proficiency and judgment that individual clinicians acquire
through clinical experience and clinical practice – with the best
available external clinical evidence from systematic research.4
The original definition of evidence-based medicine focused

on the identification and compassionate use of individual
patients’ predicaments, rights and preferences in making
clinical decisions about their care. In recent years, there has
been increased acknowledgement of the importance of such
individual patient factors and of evidence-based patient choice5
(see ‘person-centered care’ above).
The educational philosophy underpinning the curriculum

The curriculum is based on an educational philosophy that
recognises general practitioners are adult life-long learners
who work within a constantly changing health environment.
It recognises that general practitioners seek needs-based,
experiential learning in which self-evaluation, reflection and
critical analysis of current practice play an important part.
The curriculum supports both guided and independent, self-
directed learning. It recognises that adult learners want to apply
what they learn and that their learning needs to be primarily
situational and problem-based.
The curriculum recognises the need of adult learners for clarity

and transparency in learner outcomes and recognises too the
cultural and ethnic diversity of general practice registrars and
their patient populations.
Vertical integration
Vertical integration underpins the curriculum, ensuring there
is an educational continuum from the early postgraduate
years through to vocational registration and continuing
professional development. This is a tool that will be relevant
to developing undergraduate programmes. This progression
allows for learning appropriate to the stage of development
of the general practitioner. The curriculum identifies the core
competencies for general practice and the syllabuses identify
competencies for each stage of the education pathway.
Reviewing and updating the curriculum

The College is committed to ongoing monitoring of the
relevance, currency and efficacy of the curriculum and
syllabuses. Reviews will occur as required based on formal
research, evaluation and internal and external moderation.

Part 4 – Delivering the curriculum
Part 4
Delivering the curriculum
The major educational goal for the general
practice registrar is the transition from a
hospital-based, episodic, reductionist model
of providing treatment for sickness, to a
community-based, continuous, holistic model
of health care. The emphasis is on health
promotion and prevention or the earliest
possible intervention.
Patients, as we know, do not present to general practice The curriculum is delivered through a range of diverse
in isolation. They bring with them a variety of symptoms, learning experiences. Many of these experiences will take
questions and concerns, interwoven with a cultural, place within a variety of general practice and other vocational
environmental, socioeconomic, spiritual and family scope environments.
background that makes each consultation unique.
In their first year the registrar is supported through a one-with-
Te wheke,6 one of the Ma-ori models of health, illustrates one learning relationship with a College Fellow. This ‘apprentice
the reality of general practice and the far-reaching effects relationship’ can be described as education and service
of health and illness. To become competent in the science blended together for professional growth and development in a
and the art of general practice, general practitioners must supportive general practice educational environment.
work with patients, wha-nau and the general practice team to
guide and support initiatives that will build on the strengths As the registrar progresses through the vocational education
and assets of everyone and encourage positive health and pathway of the programme, their learning will become
wellbeing, within the framework of the community in which increasingly independent and self-directed.
they belong – a little like finding the pieces of a jigsaw and
fitting them together to make a whole picture.
General practice education reflects the complexity of the

discipline and the curriculum addresses six domains of
general practice along with some common themes. While
many educators may be involved in delivering the curriculum,
general practitioners of today must continue to lead the
education of the general practitioners of tomorrow.
6
http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-wheke

The learning experiences will include: The learning environment
The curriculum will be delivered in a number of educational
contexts depending on the level of learning. Registrars in
• individual learning with a vocationally registered
their first year of training will be placed in accredited teaching
general practitioner
practices7 with support from a GPEP teacher and medical
• video analysis of consultations educators. In conjunction with the clinical placement, there
are regional day-release seminars and workshops. These
• sitting in and observing the consultation styles of general provide the opportunity to review and reflect on practice
practitioners and other health professionals experiences with peers. As well as covering core topics,
clinical skills and knowledge, topics for each seminar are
• a medical educator sitting in on consultations structured using a training scaffold that links the topic to the
curriculum statements and domains of general practice.
• case-based learning
Senior registrars in their second and third years of training
• research
will be based in approved general practice environments
• evidence-based learning activities with support from a visiting medical educator, and will have
access to modular online learning and small, self-directed
• patient satisfaction questionnaires learning groups led by a medical educator. Senior registrars
may identify learning needs that are best met through
• peer discussion and review further training under other vocational scopes in either
hospital-based or community environments and/or through
• patient record review
completing postgraduate diplomas or certificates.
• use of log books to document learning and assist reflection
Assessment of learning
• structured peer group learning The College views assessment as an important part of the
process of learning. Clinical skills, knowledge and attitudes
• role-played consultations for general practice will be assessed throughout the
vocational pathway.
• online learning
• inter-professional learning Curriculum delivery will be underpinned by formative

workplace assessment to ensure structured feedback forms
• community-based experiences an integral part of learning. This feedback will be informed
by a range of means including logbooks, role play, registrar
• opportunities for reflection consultations with the teacher or medical educator present,
small group learning, problem-based learning, record review
• formal structured learning, such as seminars, workshops and career plans.
and clinics
Summative assessments will evaluate the learning and
• training under other vocational scopes
provide formal recognition that registrars have achieved the
• academic output. competencies required, and are ‘fit for purpose’ and safe
for independent, unsupervised practice when they have
completed their training.
7
RNZCGP Teaching Standards 2012

Part 5 – Curriculum domains
Part 5
Curriculum domains
The curriculum identifies the competencies
(the skills, knowledge, values and attitudes)
required of a general practitioner working in
primary care in New Zealand. The curriculum
is organised under six domains.
Curriculum domains Page No.
1. Communication 14
2. Clinical Expertise 16
3. Professionalism 18
4. Scholarship 21
5. Context of General Practice 22
6. Management 24
Domain statements
Each domain defines the core competencies to be achieved.
The term ‘competency’ is used to describe the ability to use
knowledge, understanding and practical skills to the national
standard required of a vocationally registered general
practitioner in New Zealand.
In domains 3, 4 and 6, further competencies have been

identified. These are competencies a Fellow of the College can
aspire to as they gain further experience in general practice.
A general practitioner who achieves Fellowship of the

College has by definition achieved the defined standards for
independent practice as a general practitioner in New Zealand.

Domain 1 – Communication
Domain 1
Communication
Good communication skills enable general
practitioners to develop effective patient and
family/wha-nau-centred relationships. They
establish and maintain rapport with patients
and, where appropriate, their families/wha-nau,
forming therapeutic partnerships in an
environment characterised by trust, empathy,
confidentiality and cultural competence. They
use skills, such as motivational interviewing
and extended consultation or counselling,
when appropriate.
Effective communication skills enable the general practitioner Skilled communication facilitates effective relationships with
to move freely between the patient’s experience and clinical the patient, family/wha-nau, the general practice team, other
problem-solving. This includes managing the consultation health providers and community agencies. This implies
in a way that allows patients and their families/wha-nau an ability to concisely and accurately convey relevant
time and space to express their ideas, needs, concerns, information in both written and oral forms. Increasingly, this
beliefs and expectations. The general practitioner elicits and may include electronic communication.
understands the patient’s perspective of their illness.
Engaging in ethical practice is a conscious component of

the consultation, for example maintaining confidentiality and
professional boundaries.

Core competencies
Fellows of The Royal New Zealand College of General Practitioners are able to:
• communicate competently and sensitively and in ways that • use a range of interviewing and counselling skills
facilitate optimal patient care and patient satisfaction with appropriately to help patients maintain or change
the consultation behaviours
• recognise the health literacy needs of the patient and their • relate effectively to patients of different life stages, cultural
family/wha-nau backgrounds, gender, socioeconomic status and beliefs
• communicate effectively and appropriately in situations • communicate effectively with other professionals in the
where there is impairment and/or language barriers practice team, and the wider primary care field, and with
medical colleagues working in other specialties
• elicit the relevant information needed to take an • provide patients with relevant information about
appropriate history conditions, treatments and risk, seek informed consent
and negotiate management plans
• establish person-centred relationships with patients • use accurate and concise writing skills to keep
and their families/wha-nau characterised by a focus on appropriate patient records and communicate with other
the patient’s and wha-nau needs, concerns, beliefs and health providers
expectations
• incorporate the principles of Te Whare Tapa Wha and • communicate safely and effectively by electronic media.
similar models of health into their consultations where
appropriate
• manage consultations efficiently within time constraints

while ensuring the patient’s needs and those of their
family/wha-nau needs appropriately met

Domain 2 – Clinical Expertise
Domain 2
Clinical Expertise
General practitioners integrate clinical
knowledge with patient-centred skills in
focused history-taking, physical examination
and in using investigations to reach a
diagnosis or understanding of patients’ health
needs across the scope of general practice.
They develop a clinically appropriate management plan using a Safe patient care requires general practitioners to work within
range of skills, including procedural interventions, therapeutics, the limits of their personal expertise and with an awareness
pharmacotherapy and integration of care with other health of causes and incidence of adverse events, including
providers. They take into account geographic, cultural and iatrogenesis. Uncertainty in diagnosis and management is
socioeconomic factors of the patient and their community. handled transparently and safely.
General practitioners demonstrate knowledge of cultural General practitioners undertake and provide inter-professional
characteristics that impact on clinical presentation and education enabling them to both share and appreciate the
management. expertise and breadth of the primary care team.
They competently manage common health needs while being

alert to the possibility of serious illness. They recognise and
respond appropriately to the needs of the significantly ill
patient, engaging the skills of other health professionals as
required. Evidence-based medicine underpins their decision-
making and health management to optimise health outcomes.

Core competencies
• manage the consultation event in an ordered, responsive, • use appropriate screening tools to identify health-related
culturally competent and integrated manner risk factors
• use diagnostic skills, including history taking, physical • apply knowledge of epidemiology to all aspects of
examination skills and investigations, as appropriate patient care
• use clinical reasoning to develop a working diagnosis • ensure continuity of care by developing timely plans
and refine this diagnosis through further investigations, for referral and follow-up, where appropriate
as appropriate
• acknowledge clinical uncertainty and respond • recognise and manage clinical risk in all aspects of
appropriately to it patient care
• develop an appropriate management plan in negotiation • recognise their own skills and knowledge and respond
with the patient using evidence-based medicine and appropriately to limitations
best practice
• prescribe treatments safely and appropriately • promote and enable patient self-management, self-help
and autonomy
• use procedural skills safely and appropriately • apply appropriate skills to manage emergency
presentations.
• use planned and opportunistic approaches to provide

screening, preventative care and health promotion activities

Domain 3 – Professionalism
Domain 3
Professionalism
General practitioners have respect and
compassion for their patients. They are
committed to developing and maintaining
personal and professional behaviours and
relationships that support and enhance
general practice care.
General practitioners have an awareness of self and the General practitioners manage professional obligations
impact of their personal values, attitudes, behaviours, and boundaries ethically and manage ethical dilemmas
limitations and circumstances on the professional role. They effectively. Probity (defined as honesty, complete integrity
also have an understanding of the impact of the professional and uprightness in all dealings) is a fundamental attribute for
role on themselves and their own family/wha-nau. the general practitioner.
They understand professional responsibility and the social General practice now takes place not only in the consulting
contract and are accountable for personal and professional room but on the telephone and via the computer, and with
actions. They have a commitment to acquiring and further technological advancements will take place in other
maintaining the range of professional competencies required electronic forums. General practitioners need to keep abreast
of general practitioners. of advancing technology and recognise the boundary
issues associated with the electronic age. It is important
they practice competently and ethically – standards of first
class patient care, privacy and cultural competency must be
upheld wherever the consultation is taking place.

Core competencies
• display appropriate values and attitudes including caritas, • display insight and awareness of self and the impact of
trustworthiness, accountability, respect for the dignity, their own attitudes, values and behaviours on clinical
privacy and rights of patients, concern for their relatives, practice and professional relationships
and provision of equitable care
• demonstrate culturally competent behaviours in all • use health service funding responsibly
aspects of practice
• demonstrate a commitment to maintaining professional • recognise the impact of the professional role on self and
standards and responsibility on family/wha-nau and take appropriate steps to maintain
self-care
• maintain professional integrity and adhere to ethical • recognise their own limitations and use a range of
principles strategies to evaluate, maintain and advance their own
professional competence within the scope of general
practice
• understand causes of health inequalities and promote • share knowledge and skills with trainees and colleagues
health equity for all groups (including through the use of from a range of disciplines
Ma-ori models of health)
• work appropriately with confidential information • develop professional networks with peers for mutual
learning and support
• keep adequate clinical records • ensure that appropriate systems are in place to ensure a
safe practice environment for patients, staff and all who
cross the threshold
• observe and keep up to date with the laws and statutory • advocate for the patient in dealings with the broader
codes affecting general practice health system.

Domain 3 – Professionalism
Further competencies
As further experience in general practice is gained, Fellows of The Royal New Zealand College of General Practitioners
are able to:
• plan their own career direction and take steps to meet • provide both formal and informal collegial support for peers
career needs
• take on professional roles that contribute to the profession • initiate quality accreditation processes in the practice
and benefit health care in New Zealand
• facilitate the learning of trainees at all levels, peers, • undertake clinical leadership roles in primary care and in
multi-professional colleagues and the community the wider health sector.

Domain 4
Scholarship
Scholarship leads the development of the
discipline of general practice, refining its
content and approaches.
General practitioners consider and apply the most up-to- General practitioners apply the principles of critical appraisal
date evidence in delivering high-quality care to patients to medical information and contribute to developing and
and recognise those areas in which the evidence base is disseminating new knowledge through research.
necessarily limited. They use audit, peer review and other
activities to continuously improve quality of care. They identify and address their learning needs and facilitate
learning and assessment of registrars and colleagues. General
practitioners also contribute to community education.
Core competencies
• reflect on their own practice, identify their own learning • develop skills in teaching and educational facilitation
needs, seek ways to meet these needs and evaluate and contribute to postgraduate medical and vocational
outcomes education and to the education of the primary care team,
patients and colleagues
• maintain comprehensive and current knowledge and • understand statistical terminology and competently
critically appraise sources of information for evidence- apply it in practice
based clinical decision-making
• undertake activities to ensure continuous quality • keep comprehensive notes and write appropriate referrals.
improvement
are able to:
• gain additional advanced skills and knowledge in specific • help develop clinical guidelines, practice standards,
areas of general practice and other quality resources for general practice
• undertake research, publish and present papers on • undertake academic leadership roles in primary care.
research findings relevant to primary care

Domain 5 – Context of General Practice
Domain 5
Context of General Practice
New Zealand is a country of diverse
communities: socioeconomic, urban,
provincial, rural, isolated. The particular needs
of any community provide challenges for
delivering high-quality primary health care,
but also provide opportunities for developing
creative, community-based solutions.
General practitioners understand the determinants and General practitioners are skilled at working inter-professionally,
differences in health care status among diverse groups in a practice team, and across the continuum of primary and
in New Zealand and facilitate equitable access to health secondary care. They access and use resources to balance
services and outcomes for all New Zealanders. They engage, individual and population health needs and outcomes. In
where appropriate, in developing health care systems doing so, they understand the range of general practice
using the skills of advocacy in response to patients, their models, their governance, operational systems, ethical
community and broader societal needs. frameworks, and other factors that influence the effectiveness
and efficiency of primary health care delivery.
General practitioners understand the history and role of the
Treaty of Waitangi in New Zealand society and its relevance General practitioners are able to observe, critically analyse,
to health care. They are committed to reducing Ma-ori and synthesise and modify their practice in response to changes
non-Ma-ori disparities in health outcomes. Additionally, and developments in health and health care systems
general practitioners support the Ministry of Health Ma-ori nationally and internationally.
Health Strategy He Korowai Oranga, which encourages
wha-nau, hapu-, iwi and Ma-ori community aspirations to take
ownership of their personal health and wellbeing.

Core competencies
• understand and apply the principles of the Treaty of • engage in activities aimed at improving population health
Waitangi to general practice as well as providing individual care
• identify the societal, cultural, economic, spiritual, gender, • understand how patient situation and context may impact
environmental, geographic, demographic, occupational on health and provide appropriate patient support
and other factors that impact on health and illness
• identify a range of factors that can impact on accessing • use resources equitably and cost-effectively, balancing the
health services and resources and develop appropriate needs of individuals and populations
responses
• work effectively within an inter-professional practice team • respond appropriately to local and global changes that
impact on general practice
• acknowledge the skills and resources of others in • coordinate with other healthcare providers, organisations
working collaboratively to deliver health care and agencies and allied professions including local
providers
• advocate on behalf of patients and the community when • understand the local practice population and its health
appropriate issues
• advocate to improve the health of the enrolled patient • coordinate patient care, taking the lead when appropriate.
population and the wider community
• be aware of the range of integrative and complementary

medicine in the community and acknowledge different
attitudes and cultural norms

Domain 6 – Management
Domain 6
Management
The vast majority of patient contacts in the
New Zealand health system occur in general
practice. The general practitioner manages
a wide range of health and social problems,
using a variety of skills and resources. The
complex environment in which this care
is delivered demands that the general
practitioner takes into account the individual,
local and national health priorities.
As general practitioners do not practise in isolation,
managing resources involves employing, educating and
motivating staff, co-ordinating the work of others, planning
and monitoring the health outcomes and taking responsibility
for the process.
In New Zealand, administering and contracting health

services is continuously being devolved from central
government to more local units of organisation. Governing,
managing and co-ordinating services is increasingly being
undertaken by general practitioners.
General practice is an ever-changing environment and

managing change is essential for general practitioners for
the future.

Core competencies
• develop and implement practice policies and systems for • demonstrate an awareness of the advantages of full
effective management of patients engagement of all members of the primary care team
• contribute to the broad management functions of • use every opportunity to appropriately share knowledge
health services, including human resources, employment, and skills gained through their own experience and training
business and clinical governance
• use information management skills to manage patient data • reconcile the needs of the individual general practitioner
efficiently and ethically and practice with the needs of the wider health economy
• reconcile differences in access to health services • reflect on the health needs of the community in which they
according to rurality, socioeconomic and cultural work and develop innovative strategies to meet these
determinants, as relevant needs, recognising the integral part that primary care has
to play.
• recognise that for the best patient outcome there must

be a team approach to primary care with the general
practitioner in a leading role, working respectfully and
co-operatively with other professionals and disciplines
are able to:
• develop skills in strategic planning and use them to • assess and lead further development of the practice as a
develop and improve health services and promote business, meeting the needs of staff, patients and the
general practice wider community
• appraise and evaluate the need for proposed changes, • apply a range of business, information, practice and
and develop skills to implement these employment management strategies appropriate to the
general practice context.
• advocate for ongoing opportunities for all team members

to operate at the top of their scope while continuously
extending their skill levels

Part 6 – Curriculum statements
Part 6
Curriculum statements
The curriculum is a dynamic, working
document for those teaching and learning in
the general practice discipline, one that states
and restates what people must learn if they
are to become effective general practitioners.
The curriculum statements are indicative
of what is current and offer a vision for the
future. They provide a base from which new
concepts and structures will grow.
The three key concepts of general practice have been The generalism of general practice is apparent in the range
applied – person-centeredness, generalism and evidence. of knowledge areas in the curriculum. Each statement
contains core content and competencies, but in places
The knowledge, skills and values identified in each of exceeds that requirement to give more scope for the
the curriculum statements are relevant to all aspects of trainee general practitioner and a curriculum for continuing
the curriculum framework and general practitioners are professional development.
encouraged to integrate key critical thinking, critical appraisal
and research skills with their role as professional practitioners. General practitioners see diverse groups of patients. They
have the key advantage of working with the patient in context,
Each of the curriculum statements follows a similar format. and develop a very thorough and wide-ranging understanding
of the social, political, cultural and economic contexts of their
Rationale patients. This knowledge informs the skills and attitudes of
Each statement has an explanation and justification for why the general practitioner and makes their role both crucial and
it is included in the curriculum. This is based on evidence unique. The curriculum statements reflect this.
about its significance for general practice. Each statement
takes into consideration the nature of general practice, Ongoing curriculum refinement by the College will be
national health goals and targets, and the prevalence of a continuous process through developing syllabuses,
conditions in the context of New Zealand society. learning programmes and assessments for each phase
of vocational education.
The domains
Each domain outlines a set of broad aims connecting the key
aspects of general practice with the curriculum topic. The
key concept of person-centred care is kept up front and the
relevant skills, knowledge and attitudes required of a general
practitioner are outlined.

Acute Care 28 Mental Health 97

Addictions 34 Musculoskeletal 103
Adolescent/Rangatahi/ Neurology 107
Youth Health 38 Older People 111
Cardiovascular 42 Oncology 115
Dermatology 47 Paediatrics and
e-health 51 Immunisations 119
End-of-life Care 55 Population and Public
Endocrinology 59 Health 124
Ear, Nose and Throat 63 Renal and Urology 128
Eyes 66 Respiratory Medicine 131
Family Violence 69 Rheumatology 135
Gastroenterology 73 Rural 138
Genetics 77 Sexual Health 143
Health and Work 80 Travel Medicine 147
Long-term Conditions 85 Women’s Health 150
Ma-ori Health 89
Men’s Health 94

A Acute Care
Acute Care
Acute care is, broadly speaking, managing
illness or accidents in patients who present
acutely, i.e. unscheduled, in a practice or in
the community. There may be considerable
discordance between a doctor’s view of what
is an acute problem and a patient’s view, and
there may be many other factors affecting the
manner and timing of presentation.
Managing acute presentations may be challenging, In rural areas, acute care is a far more significant part of
satisfying, disruptive, frustrating or even frightening, but the general practitioner’s daily work, with the rural practice
it is part of general practice and good patient care. The and/or community hospital acting as the emergency
immediate care of people suffering in these conditions department. The doctor on duty must be prepared to
is paramount to their long-term health outcome. manage any patient who walks, or is carried, through the
door, or who they are called to urgently. This requirement is
How much acute care a GP has to do will depend on one of the defining features of rural medicine and can seem
the practice’s location in terms of distance and time from daunting or overwhelming.
an emergency department. Also impacting on the type
and frequency of the acute care is the practice General practitioners need to cope with a variety of traumatic
demographics. Ma-ori, Pacific and some rural patients and medical emergencies, as well as acute minor trauma.
will tend to present with more serious and advanced illness Life-threatening emergencies will require hospital intervention
than other New Zealanders.1,2 The organisation of the and general practitioners require the knowledge and triage
practice may allow for acute presentations, for example it skills to choose the appropriate management.
may have nurse or doctor appointments kept open for acute
presentations and/or it may have an after-hours arrangement.
There are now initiatives in some urban areas of

New Zealand that allow more advanced investigation,
management and observation of patients in primary care
urgent and after-hours centres to reduce pressure on
overcrowded emergency departments. These initiatives
allow general practitioners the challenge and satisfaction
of managing acutely ill patients, and help to provide a more
patient-centred model of care.3
1
Craig E, McDonald G, Adams J, Reddington A, Oben G, Simpson J, Wicken A. 2012. Te Ohonga Ake 1: The Health of Ma-ori Children and Young People with Chronic
Conditions and Disabilities in New Zealand. New Zealand Child and Youth Epidemiology Service: Dunedin.
2
Baker MG, Barnard LT, Kvalsvig A, Verrall A, Zhang J, Keall M, Wilson N, Wall T, Howden-Chapman P. 2012. Increasing incidence of serious infectious diseases and
inequalities in New Zealand: a national epidemiological study. Lancet; 379:1112-9.
3
Ardagh M. 2010. How to achieve New Zealand’s shorter stays in emergency departments health target. Journal of the NZ Medical Association.

Acute Care A
Communication
The GP will demonstrate the ability to:
• effectively assess acute illness in a telephone consultation, • communicate with and ask advice from colleagues in
eliciting appropriate details and history, and give the primary care team, including nursing staff and
appropriate advice for home care or need for further specialist colleagues
assessment
• take a relevant and focused history appropriate to • ensure systems are in place to inform other medical
a general practice environment from a patient practitioners involved in patient care of relevant
presenting acutely information to provide seamless continuity of care.
• understand the importance of communicating with

patients and family/wha-nau when obtaining informed
consent for management options, plans and treatments
Clinical Expertise
The basics
The GP will demonstrate:
• proficiency in resuscitation skills to a minimum of Level 5 of • awareness of their limitations and an ability to seek
the New Zealand Resuscitation Council standards, plus advice (when in doubt).
further training in acute care as appropriate to location,
for example APLS, PRIME
• a clear, robust and systematic approach to acute care

that ensures safe practice for themselves, the patient and
their staff
Cardiovascular
• assess and manage cardiovascular presentations including but not limited to chest pain (including differentiation,
initial or definitive treatment, and referral with or without pre-hospital treatment appropriate to the practice location); acute
arrhythmias; an acute cerebrovascular event; possible deep vein thrombosis including knowledge of diagnostic pathways,
local protocols and initial management in the community; and acute peripheral arterial insufficiency
Cardiorespiratory
• assess, differentiate and manage acute breathlessness, including rational clinical decision-making for severity and the
need for secondary assessment or hospitalisation versus management in the community, and secondary prevention in all
age groups, including children.

A Acute Care
Clinical Expertise
Gastrointestinal
• knowledge of causes of acute abdominal pain and/or • management of acute gastrointestinal bleed, including
vomiting in children and adults, and differentiation and resuscitation and appropriate referral and transfer,
appropriate management, including pre-hospital treatment knowledge of local referral and admission pathways.
Genitourinary
• diagnose renal colic, initiate immediate management • identify and manage acute ectopic pregnancy and
and have knowledge of local referral pathways for further miscarriage and other obstetric emergencies
investigation and management
• manage acute urinary retention, catheter insertion • identify acute testicular torsion.
and management
• identify and manage the entire spectrum of

genitourinary infection
Skin
• recognise, assess severity of and manage cellulitis, • identify and manage acute urticaria.
including rational prescribing of oral antibiotics and
community intravenous antibiotics when appropriate
Ear, nose and throat

• manage epistaxis, including patient education for • identify and manage conditions that may compromise
physical positioning and pressure, intranasal medications, the airway, for example quinsy, foreign body in the airway.
cautery and nasal packing or tamponade if needed
Eyes
• confident assessment and management of the acute • competent examination for and removal of a simple
red or painful eye foreign body on the surface of the eye or under the
upper lid.
• appropriate assessment and management of a patient

with sudden visual loss

Acute Care A
Clinical Expertise
Neurology
• assess acute headache, including red flags • assess and manage patients post traumatic head injury
and advise appropriate follow-up.
• manage acute seizures in children and adults, including

immediate management, management of status
epilepticus, and appropriate transfer or referral
Infection
• diagnose and appropriately treat community-acquired • recognise sepsis and be able to initiate the appropriate
pneumonia in adults pre-hospital antibiotic treatment for children and adults.
Trauma
• manage a variety of wounds • assess and manage fractures
• assess and immediately manage burns appropriately • manage dislocations where appropriate.
Metabolic
The GP will demonstrate the ability to identify and manage acute metabolic emergency conditions:
• Anaphylaxis • Hyper/hypokalaemia
• Angioedema • Hyper/hypocalcaemia
• Diabetic keto-acidosis

A Acute Care
Professionalism
• maintain the skills needed for acute care appropriate • negotiate with funders (health board, local trust etc), as
to the practice type and location necessary
• place patient safety as the priority, recognising their • facilitate training opportunities for the primary care team
limitations and seeking help or advice appropriately
• have their patients’ welfare and safety as their first priority • ensure they have an appropriate support network in
(apply the litmus test of ‘What would I want to happen if place for their own self-care
this was a member of my family?’)
• show willingness and have the ability to lead and work • realise it is an ethical obligation to provide emergency
as part of a team to provide the best overall patient care first aid care in any situation, whether on or off duty until
necessary help services arrive
• maintain staff, equipment and premises suitable to • participate in acute care provision and/or ensure this
provide acute care is in place for patients enrolled in their care.
Scholarship
• maintain the necessary skills needed for acute care • audit significant events and deal with them appropriately.
appropriate to the practice type and location
• show a willingness to teach and support the primary

care team in acute care
• develop and maintain a good working relationship with • delegate to other team members who might have
local base hospital acute services, ambulance services, more skills or knowledge, such as nursing colleagues,
mental health services, police and other individuals or mental health staff and paramedics.
agencies involved in acute care, such as the fire service
• be aware of developments in IT to facilitate the best

care when patient’s records are not available, for
example Care Insight

Acute Care A
Management
• manage acute care provision, especially out of hours, in • learn and make use of new technologies that facilitate
such a way that the service is safe for patients and staff acute care
and sustainable, including standing orders and protocols
• involve and lead the wider primary care teams in acute • ensure systems are in place to allow for reasonable acute
care provision, for example nurse triage and assessment, care requirements and ‘business as usual’ scheduling for
local ambulance service, rural hospital staff the practice population.
• understand the funding issues and the related stresses

in acute care provision
This curriculum statement links with all

others in the series.

A Addictions
Addictions
The effects of addiction are far-reaching,
and no sector of New Zealand society
is exempt. Addiction has an impact on
individuals, families, communities and beyond.
It is linked to poverty, crime, accidental
and non-accidental injury and poor health
outcomes. A growing number of people who
have an addiction also experience a mental
illness.1 It is an area in which most general
practitioners will recognise conflicting values,
and in which it is all too easy to make hasty,
ill-considered judgments.
Addiction is wide-ranging and can include alcohol, tobacco, We know almost half of all New Zealand adults aged between
recreational and prescription drugs, other substance misuse, 16 and 64 years have used drugs for recreational purposes,
problem gambling and other gaming, sexual addiction, and that a third of those who seek help to reduce their use of
obsessive shopping, eating disorders, obesity and social drugs seek that help from their general practitioner.3
networking. Some of these may be increasingly fuelled by
ease of access to the internet. Harmful effects on individuals Ma-ori are twice as likely to smoke tobacco compared to
and families may be compounded by co-dependent or non-Ma-ori, with the highest prevalence of smoking being
dysfunctionally enabling behaviour by family members and in Ma-ori women.4 Ma-ori are also more likely to be regular
health professionals. cannabis smokers, and to have started smoking cannabis
when aged less than 14 years. While non-Ma-ori are more
The general practitioner should be competent in likely to consume alcohol, Ma-ori are more likely to drink at a
recognising signs or symptoms of addiction, including hazardous level.5
co-dependency. Family history is becoming increasingly
evident as a factor in addiction, so using wha-nau ora2 Misuse of prescription drugs is of particular concern as most
principles and concepts is essential if we are to break the are obtained from general practitioners; doctors themselves
cycle of addiction within families. are especially at risk and should be wary of prescribing for
colleagues or for patients who are unknown to them.
1
Ministry of Health. 2005. Te Tahuhu: Improving Mental Health 2005-2015: The Second New Zealand Mental Health Plan. Ministry of Health, Wellington.
2
Ministry of Health. 2002. He Korowai Oranga – Maori Health Strategy. http://www.maorihealth.govt.nz
3
Ministry of Health. 2010. Drug use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey
4
Ministry of Health. 2006. Tatau kahukura: Maori health chart book.
5
Ministry of Health. 2006. Tatau kahukura: Maori health chart book.

Addictions A
Communication
• take a careful history, exploring problem gambling, alcohol • involve family/wha-nau in discussions and solutions
and drug use, as well as co-morbidities where appropriate
• identify and follow up any areas of potential concern, such • foster an effective relationship with the patient in the initial
as non-accidental injury, motor vehicle accidents, frequent consultation that encourages follow-up and/or a
falls or disproportionate poverty subsequent consultation
• take a non-judgemental approach in the use of language, • demonstrate strategies to manage conflict within the
avoiding the temptation to get caught up in semantics consultation, for example dealing with drug seekers or
inappropriate requests for certification.
• ensure the patient understands the limits of confidentiality

versus safety
Clinical Expertise
• use and interpret appropriate screening tools and be able • develop skills to help with community detoxification
to explain the process to patients
• assess the motivational stage of an addicted patient • explain to patients and their family/wha-nau the nature
of addictions and that they are chronic and relapsing
disorders
• offer brief interventions and adeptly introduce an • discuss with patients and their family/wha-nau the
intervention into the consultation health, financial and psychosocial problems resulting
from addictions
• recognise and manage acute conditions, such as • develop a working knowledge of the various treatments
intoxication, psychosis or withdrawal and programmes available so that appropriate care can
be planned
• negotiate a plan for ongoing management and refer • prescribe medications appropriately for various aspects
appropriately; this may include family support, for example of addiction, for example detoxification, methadone
children with foetal alcohol syndrome programme.
• consider relevant co-morbidities and investigate

accordingly, for example blood-borne infections
and/or depression

A Addictions
Professionalism
• understand their practice policy and process for accessing • describe the process by which they can raise
immediate support if needed to ensure their safety and concerns about a colleague
the mechanism to debrief after difficult consultations
• adhere to Medical Council guidelines when treating • be aware of the circumstances under which GP
patients and colleagues with addictions performance and competence can decrease
• reflect on ways to manage a consultation when they and • describe the local process for relaying information about
the patient have conflicting values drug-seekers to other practitioners
• recognise which prescription medicines have street • outline the medico-legal issues in relation to alcohol and
value and be alert for potential misuse drug use, for example when driving
• pay attention to their own self-care; doctors are not • describe the legal obligations, rights and responsibilities
exempt from addictions either from key legislation for confidentiality, prescribing
and certification for all patients and especially for those
dependent on controlled drugs.
Scholarship
• document all discussions accurately and carefully • use opportunities to up-skill and maintain awareness
of the issues surrounding addiction.
• evaluate prescribing of potentially misused

prescription drugs and compare with colleagues

Addictions A
• familiarise themselves with local agencies who treat • use the principles of Te Whare Tapa Wha-, exploring
and support patients and their family/wha-nau living the impact of addiction on patient, family/wha-nau,
with addictions, recognising the particular challenges workplace and community
in small or rural communities
• consider the role of culture in addiction • consider the relationship between addictions and
socioeconomic factors and how each affects the other.
Management
• collaborate with the primary care team to ensure a • develop and/or review practice policies for safe
co-ordinated and consistent approach to patient care prescribing, including e-prescribing.
This curriculum statement links with:

• Acute Care - Page 28
• Long-term Conditions - Page 85
• Mental Health - Page 97

A Adolescent/Rangatahi/Youth Health
Adolescent/Rangatahi/Youth Health
Adolescence is a dynamic developmental
period that does not always happen
continuously, and with no measurable
endpoint. It is a period of intense change and
vulnerability during which expectations, goals
and rites of passage vary widely.
Young people (rangatahi) have specific developmental For young people, general practitioners play a vital role in
needs and health problems that can be influenced facilitating access to health services; it is vital that general
by a range of factors, including cultural background, practitioners are aware of the significant barriers that may
socioeconomic status, geography, family structure, abuse, make our rangatahi reluctant or infrequent users of services.
neglect or homelessness. Engaging with young people and developing a trusting
relationship is likely to be the most important skill and will
In New Zealand adolescents are a culturally diverse group affect outcomes, regardless of the presenting complaint.4
that accounts for over 20 percent of the population. For A warm, empathic and non-judgmental approach facilitates
rural youth there may be a particular risk of alcohol misuse effective interventions, which will be less successful if the
and drunk driving; for Ma-ori,1 depression, suicide and value systems of the general practitioner are imposed on
disability rates are higher. Refugee youth also have specific the young person in an authoritative or judgemental way.5
risk factors.
Creating a youth-friendly service and mastering social
While rangatahi most commonly present to general interaction with young people (with and without parents
practitioners with physical complaints, such as respiratory, present) requires awareness and enthusiasm. General
skin and musculoskeletal conditions, they are much less practice training and education aims to develop the
likely to present with the mental health and behavioural knowledge, skills and attitudes that a general practitioner
issues that are the major causes of adolescent morbidity.2 will require to work successfully with adolescents within an
The Youth ’07 study3 identified family conflict, alcohol and interdisciplinary team.
other drugs, body image, and mental health and emotional
worries as being the main issues of concern for secondary NB: Youth, adolescents, young people and rangatahi are used interchangeably
school students in New Zealand. to describe the age group from 10 to 24 years, and include all ethnicities.
1
Ministry of Health. 2009. Suicide Facts: Deaths and intentional self-harm hospitalisations 2009. Wellington: Ministry of Health.
2
The Collaborative for Research and Training in Youth Health and Development Trust. 2011. Youth Health: Enhancing the skills of Primary Care Practitioners in caring for
all young New Zealanders. Christchurch. This is an excellent resource manual for all primary care practitioners who deal with young people. [email protected]
3
“Youth ’07: The health and wellbeing of secondary school students in New Zealand” www.youth2000.ac.nz
4
Bennett DL, Kang M. 2011. Communicating with adolescents in general practice. In “The Missing Link – Adolescent mental health in general practice.”
Alpha Biomedical Communications, NSW.
5
Christie, G. 2008. The Substances and Choices Scale Brief Intervention. Werry Centre for Child and Adolescent Mental Health.

Adolescent/Rangatahi/Youth Health A
Communication
• describe the boundaries of confidentiality and • confirm contact details and establish a means of
demonstrate strategies to negotiate who will be present ongoing communication, for example for test results
during consultations
• communicate according to the level of cognitive • discuss safe sex, unintended pregnancy, sexual
development of the young person orientation, risk-taking behaviour, violence, eating
disorders, relationships with both family and peers,
emotional concerns and other issues using
appropriate, non-judgemental language, normalising
where appropriate
• engage the young person and establish rapport, • negotiate a mutually acceptable management plan
developing effective relationships with them and their
family/wha-nau
• obtain a history, bearing in mind factors specific to • consider patient factors when obtaining consent for
rangatahi observation of consultations or attendance by doctors
in training.
• find out what the young person considers to be ‘normal’

A Adolescent/Rangatahi/Youth Health
Clinical Expertise
• recognise levels of cognitive and physical development, • manage chronic disease in a manner that is appropriate
and distinguish between normal and abnormal to the individual, remembering that most strive to be
developmental changes in young people ‘normal’, and encourage self-management
• recognise the potential for enhanced risk-taking in • assess mental status, paying particular attention to
those with disabilities or chronic illness suicide risk
• assess young people using an appropriate framework • perform appropriate testing and treating for STIs, and
(e.g. HEADSSS), taking into account the impact of differentiate between screening and symptomatic testing
cultural issues, including the impacts of immigration
on young people and their family/wha-nau
• manage common health conditions presenting in youth • provide competent contraceptive advice and education
on safe sex
• identify risk and resilience factors • anticipate and address potential issues with prescribing
– financial, safe storage and use of medications,
medication sharing
• ask about factors that aid healthy development and • understand key developmental tasks of adolescence,
resilience such as establishing independence and autonomy,
forming identity, affiliating with peers, achieving legal
permission to engage in adult activities such as driving,
voting, drinking and smoking, and navigating exposure
to intoxicating and addictive substances.
Professionalism
• describe the role of the doctor in assessing, advising and • have a strategy for dealing with suspicion or evidence
mediating adolescent risk-taking behaviour with the help of violence or abuse
of the interdisciplinary team
• understand the legal parameters for adolescents for • reflect on conflicts between their own values and beliefs
privacy, informed consent, sexual activity, alcohol and and those of adolescent patients, and differentiate
drug use, driving and reporting of abuse between professionalism and parentalism.
• consider the confidentiality issues that may arise when

using chaperones or interpreters, or having others
present during the consultation

Adolescent/Rangatahi/Youth Health A
Scholarship
• be aware of local prevalence for common conditions, • maintain accurate notes on consultations, indicating
such as chlamydia, and take part in screening where others are present in the consultation or
chaperones are used
• recognise the need for ongoing professional development • undertake an audit of practice performance around
appropriate for their work with adolescents adolescent health issues.
• engage with other local providers; this may include • demonstrate understanding of the particular issues that
one-stop centres, schools, Ma-ori providers, student may affect rural or disabled youth and those at boarding
health clinics, sexual health services, mental health school or in residential facilities; confidentiality remains
services, paediatrics and other specialised health paramount.
professionals, CYFS and police
Management
• consciously develop youth-friendly facilities and • contribute to health education for adolescents and other
encourage colleagues and other providers to do health professionals
the same
• maintain knowledge of other youth health services in • ensure staff have up-to-date training in skills appropriate
the area, and the ways in which the services may overlap to deal with rangatahi.
or differ particularly for funding


C Cardiovascular
Cardiovascular
Cardiovascular disease (CVD), defined as
angina, myocardial infarction (MI), ischaemic
stroke, transient ischaemic attack (TIA) and
peripheral vascular disease, is responsible
for over 40 percent of deaths in New
Zealand.1 Ischaemic heart disease was
responsible for 131 deaths per 100,000
population in 2009, one of the highest rates
in the OECD countries.2
While there has been significant reduction in the incidence differences that will have an impact on the success of any
of CVD over the past several years, our aging population health interventions. PHARMAC’s One Heart Many Lives
and increasing prevalence of risk factors, including obesity programme, encouraging Ma-ori and Pacific men to get a
and diabetes, have kept absolute numbers high. heart check, is one of the interventions that endeavours to
address this disparity.9
The rate of decline in CVD in Ma-ori has been substantially
lower than in Pacific and non-Ma-ori people,3 and still Primary prevention of CVD with education, lifestyle and
represents a considerable discrepancy in health equity. pharmaceutical intervention is a major factor in preventing
Total cardiovascular disease mortality was two and a half early death and suffering in our patients, and in reducing
times higher for Ma-ori than for non-Ma-ori between 2004 the costs and resources used in caring for affected people.
and 2006.4 The prevalence of risk factors for cardiovascular
disease varies by ethnicity.5,6 There is also evidence of Appropriate and timely investigation, diagnosis and
lower rates of interventions promoting revascularisation in management of established CVD is vital to optimising outcomes
Ma-ori.7 Screening for CVD must be started 10 years earlier and reducing subsequent disability, and management pathways
in Ma-ori patients than non-Ma-ori,8 and those involved must will vary with where a doctor practices.
have an understanding of cultural, wha-nau and life view
1
http://www.heartfoundation.org.nz/know-the-facts/statistics Accessed 26/4/12
2
http://www.oecd-ilibrary.org/sites/health_glance-2011-en/01/03/index.html?contentType=/ns/Chapter,/ns/StatisticalPublication&itemId=/content/chapter/health_glance-
2011-6-en&containerItemId=/content/serial/19991312&accessItemIds=&mimeType=text/html Accessed 26/4/12
3
http://journal.nzma.org.nz/journal/117-1199/995/content.pdf Accessed 26/4/12
4
http://www.maorihealth.govt.nz/moh.nsf/indexma/cardiovascular-disease Accessed 26/4/12
5
A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey http://www.health.govt.nz/publication/portrait-health-key-results-2006-07-new-zealand-
health-survey Accessed 26/4/12
6
http://www.health.govt.nz/publication/tobacco-use-new-zealand-key-findings-2009-nz-tobacco-use-survey Accessed 26/4/12
7
Ethnic and gender differences in the use of coronary artery revascularisation procedures in New Zealand http://journal.nzma.org.nz/journal/115-1152/2230/content.pdf
8
New Zealand primary care handbook 2012 http://www.health.govt.nz/publication/new-zealand-primary-care-handbook-2012 Accessed 26/4/12
9
http://www.hiirc.org.nz/page/17701/one-heart-many-lives/?tab=2614&section=8959
10
http://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever Accessed 26/4/12
11
http://journal.nzma.org.nz/journal/124-1329/4530/content.pdf Accessed 26/4/12
12
http://www.beehive.govt.nz/release/12m-boost-reduce-rheumatic-fever Accessed 26/4/12

Cardiovascular C
We know that after a CVD event patients are at increased Finally for this topic, acute rheumatic fever (ARF) is a
risk for progressive disease so secondary prevention, using disease that is endemic in some North Island areas of
all the same interventions as above, is vital. This must not Aotearoa, particularly in the Northland, Counties Manukau,
be overlooked. Hawke’s Bay and Capital and Coast District Health Board
areas.10 It is almost exclusively a disease of Ma-ori and
It does not take long in practice to realise that atrial Pacific people, who respectively have a 23-fold and 50-
fibrillation is extremely common and a significant risk fold increase in risk of ARF over all other ethnicities.11 ARF
factor for embolic stroke, so optimal management of this rates in New Zealand are markedly elevated compared to
is very important to our patients. As our population ages, other developed countries. In recognition of this, in 2011
increasingly more patients present with heart failure but, the Government began funding a range of programmes to
fortunately, the ability to manage this more competently combat rheumatic fever.12
in the community has advanced enormously over the past
few decades. Cardiovascular disease – largely preventable, diagnosable
and treatable – is still a huge burden on our society and
highlights inequity in Ma-ori and Pacific health and is a
central focus of general practice in New Zealand.
Communication
• communicate information about the screening process • apply knowledge and confidently undertake brief
and risk factors in a relevant and clear way to patients, intervention and motivational interviewing techniques
such that they can understand their chance of developing to address modifiable lifestyle risk factors
CVD, and how modification of risk factors will benefit
them and their family/wha-nau
• develop a non-judgmental relationship and rapport with • discuss pharmaceutical interventions, including benefits
their patient, enhancing their ability to facilitate change, and side effects, for cardiovascular disease, atrial
and recognise other life events and factors that may be fibrillation, TIA and diabetes
influencing the patient’s ability to make lifestyle change
• confidently use consultation screening methods and • understand the need, willingness and ability to involve
tools for opportunistic screening and brief intervention family/wha-nau when addressing risk factors in Ma-ori
patients.
Specific to rural general practice

• communicate the benefits and risks of pre-hospital • communicate clearly the results of any assessments
thrombolysis to a patient, and the patient’s family/ in a way that makes sense to patients, recognising
wha-nau, experiencing an acute MI in a rural setting their level of health literacy, and adjust explanations
accordingly.
• communicate the risks and benefits of staying in rural

hospital versus transfer to a base hospital to an elderly
patient, and the patient’s family/wha-nau, experiencing
a stroke in a rural setting

C Cardiovascular
Clinical Expertise
• recognise the risk factors for cardiovascular disease • recognise and discuss with the patient and their family/
wha-nau end-stage cardiovascular disease and provide
appropriate palliative care, in conjunction with the local
palliative care specialist team if available
• confidently use clinical tools and laboratory tests to assess • provide care for acute exacerbation of congestive heart
and calculate cardiovascular risk failure in the community (differentiating this from respiratory
disease and manage chronic congestive heart failure
competency)
• explain the benefits of risk modification to patients and • recognise the symptoms of stroke and TIA
their family/wha-nau
• use medication appropriately to modify identified risk • undertake a risk assessment for stroke, ensuring
factors, including knowledge of treatment guidelines appropriate immediate management and/or admission
according to local protocols
• recognise from clinical examination and ECG, commonly • provide investigation and management in the community,
encountered arrhythmias and other cardiac events, and including addressing risk factors and secondary prevention
their significance and management
• undertake family screening and appropriate assessment • undertake resuscitation skills training to a minimum
and referral of level 5 of the New Zealand Resuscitation Council
standards or to the level appropriate for their working
environment
• recognise from clinical examination commonly • order and interpret laboratory tests performed in acute
encountered heart murmurs, their significance and cardiovascular situations appropriately
management
• recognise the cardiovascular risks in young people • understand the risk of acute rheumatic fever in vulnerable
populations and describe methods of reducing this risk.

Cardiovascular C
Specific to rural general practice

• perform advanced management of arrhythmias in • diagnose, from history and ECG, with or without
a rural setting point-of-care blood testing, acute coronary syndrome
and implement an appropriate course of action
• care for a patient with a more severe exacerbation • manage cardiac arrest in children and adults,
of congestive heart failure requiring admission to a demonstrating familiarity with a defibrillator and
rural hospital appropriate airway management
• make considered, rational decisions when discussing • manage rural hospital in-patient care, rehabilitation,
with the patient and their family/wha-nau whether secondary prevention, discharge planning and
to transfer to a base hospital for investigation and appropriate follow-up.
management, or to manage in the rural hospital
Professionalism
• maintain accurate records, including information • consider cardiovascular risk and disease in the context
relevant to cardiovascular risk assessment, results of the whole person, and advise the patient accordingly
and medications
• ensure systems are in place to offer a cardiovascular • recognise serious cardiovascular symptoms and
screening service in the practice, and endeavour to promptly initiate management and/or referral and ensure
meet targets set in the PHO Performance Programme the patient is seen and referred within a safe timeframe
• perform prompt interpretation and action on test results • develop an understanding of the psychological and
social impact of cardiovascular disease on patients
and their families/wha-nau.
Scholarship
• undertake an audit of practice performance in • teach members of the primary care team about
detection and management of cardiovascular disease cardiovascular disease, its significance and management
• maintain up-to-date knowledge of management of • undertake further study appropriate to their work in
acute and chronic cardiovascular conditions relation to CVD, such as long-term condition management.

C Cardiovascular
• understand the demographics of their practice population • manage the referral and admission pathways and
to allow appropriate screening, organised or opportunistic, protocols in their local area to ensure patients receive
and awareness of prevalent conditions secondary care in an efficient and timely manner
• consider what methods would help to reach their practice • engage with other health care professionals, providing
population for cardiovascular screening in order to improve both support to reduce the risk of CVD and rehabilitation
risk factor modification and disease management following a CV event.
• consider the different members of the primary care

team and how they can each participate fully in
cardiovascular disease prevention, detection and
management in their practice
Management
• set up systems to efficiently identify and contact patients, • describe the PHO Performance Programme and its
and deliver a cardiovascular screening programme from function and relevance to practice
their practice
• initiate and maintain systems to collect and record • manage practice team organisation and leadership to
information identifying patients at increased risk of CVD, effectively deliver a CVD screening programme and risk
for example smoking, family history, ethnicity, modification intervention, and appropriate management
hypertension, diabetes of unstable CVD and effective secondary prevention.

• End-of-life Care - Page 55
• Older People - Page 111

Dermatology D
Dermatology
The skin is the largest organ in the body and
skin conditions account for approximately
15 percent of all consultations in general
practice,1 which is where most dermatological
consultations in New Zealand occur.
The New Zealand Dermatology Society definition of General practitioners require a special sensitivity to the
dermatology is: needs of particular population groups’ dermatological
needs, for example adolescents. Since 2009 vocationally
Dermatology involves but is not limited to study, registered general practitioners have been able to prescribe
research, and diagnosis of normal skin and funded isotretinoin for treating acne. The effect of this
disorders, diseases, cancers, cosmetic and ageing change on access to treatment for adolescents from lower
conditions of the skin, fat, hair, nails and oral and genital socioeconomic backgrounds and on the numbers of
membranes, and the management of these by different pregnancies in women taking isotretinoin is being studied.4
investigations and therapies, including but not limited to
dermatohistopathology, topical and systemic Young children with chronic skin problems require
medications, dermatologic surgery and dermatologic comprehensive and proactive care involving the total
cosmetic surgery, immunotherapy, phototherapy, laser commitment of parents/wha-nau and carers. Ma-ori and
therapy, radiotherapy and photodynamic therapy. (2004)2 Pacific children and those from areas of high deprivation are
at increased risk of hospitalisation for serious skin infections5
New Zealand has an ‘outdoors’ culture and suffers from and a general practitioner should be able to competently and
high rates of sun-related skin damage and cancer as a sensitively manage skin infections in these groups.
result. High rates of melanoma in New Zealand require that
general practitioners maintain up-to-date knowledge of Increasingly, new areas of dermatological practice, for
clinical evaluation and treatment methods and strategies example appearance medicine, significantly influence
consistent with melanoma guidelines.3 patient expectations. New Zealand general practice
needs to carefully consider the benefits and risks of these
In rural New Zealand, where a high level of sun exposure practices, respecting patients’ rights, resources and dignity.
occurs, general practitioners are uniquely positioned
as patients’ first point of contact to promote prevention
strategies, early diagnosis and appropriate treatment. Being
the first point of contact also enables general practitioners
to recognise where skin conditions may be the clue to
serious systemic disease, infection and malignancy.
1
http://www.rcgp-cirriculum.org.uk/PDF/curr_15_10_Skin_problems.pdf
2
http://dermnetnz.org/dermatologist.html
3
http://www.nzgg.org.nz/library_resources/8_clinical_practice_guidelines_for_the_management_of_melanoma_in_australia_and_new_zealand_
4
http://journal.nzma.org.nz/journal/124-1339/4787/content.pdf
5
http://www.nhc.health.govt.nz/sites/www.nhc.health.govt.nz/files/documents/publications/the-best-start-in-life-21may.pdf

D Dermatology
Communication
• identify the patient’s beliefs and values concerning • involve family/wha-nau members and carers in the
skin health and either reinforce, or attempt to modify, education and management plan as appropriate
these beliefs as appropriate
• acknowledge and effectively manage uncertainty • employ a caring and proactive approach to
when dealing with unusual skin conditions communicating and managing adverse outcomes.
• employ a patient-focused, confidential and non-

judgemental approach to establish and maintain
patient trust
Clinical Expertise
• apply skill in the enquiry into symptoms, eliciting of signs, • assess and manage acute skin trauma and injury, such
selection of appropriate investigations and negotiating as pretibial flap and burns
management of common skin conditions
• prescribe all treatments and medications appropriately, • take specimens for mycology from skin, hair and nail,
recognising potential side effects as well as skin biopsy for histological examination
• understand skin symptoms, including itch, rash, hair loss, • understand the indications for and demonstrate skill
lumps, ulcers and disorders of the nails in performing curettage, cautery and cryotherapy
• recognise and manage skin conditions relevant to rural • employ a complete and accurate medical record of
occupations and for patients living in rural settings all aspects of history, examination, treatment, referral
and follow-up
• employ up-to-date management of common skin • reflect on personal limitations in dermatology and refer
conditions when appropriate
• promote skin wellbeing by applying health promotion and • describe causes of inequalities with skin infections
disease prevention strategies appropriately and infestations, such as high incidence in Ma-ori and
Pacific people.
• understand appropriate skin dressings and treatments

for a variety of wounds and conditions

Dermatology D
Professionalism
• understand rongoa- and other Ma-ori traditional • apply informed consent for all dermatological procedures
treatments of skin and dermatological conditions
• work with patients to empower them to look after • recognise different cultural norms and practice in a
their own health and take responsibility for managing culturally sensitive manner
their skin problems
• comply with practice standards of infection control and • employ adequate privacy and space for disrobing
sterilisation when performing dermatological procedures and examination, as well as offering appropriate
chaperone assistance.
Scholarship
• use evidence-based practice and employ an ongoing • appraise health outcomes by undertaking audit as
commitment to continuing medical education appropriate.
• recognise the need and, where appropriate, undertake

further training to acquire the skills of advanced
diagnostic and surgical techniques
• co-ordinate care with other primary care health • analyse the impact of ethnicity on the pattern of
professionals, dermatologists and other appropriate skin disease and access to health services.
specialists

D Dermatology
Management
• recognise the risk of inappropriate referrals as well • operate an efficient system to audit and manage test
as under-referral results, which is understood by all staff and colleagues,
and is transparent to the patient
• critically appraise the organisational systems of the • recognise the impact of skin conditions, such as
practice and establish processes for staff training and infections, on the population as a whole and take steps
protocols for equipment, cleaning and sterilisation, to reduce this.
sharps and waste disposal that comply with relevant
legislation and standards

• Men’s Health - Page 94
• Paediatrics and Immunisations
- Page 119
• Women’s Health - Page 150

e-health E
e-health
The World Health Organization describes
e-health as ‘the use of information and
communication technologies (ICT) for health,’
with examples including treating patients,
conducting research, educating the health
workforce, tracking diseases and monitoring
public health.1
e-health encompasses products, systems and services e-health has significant implications for both patients and
including tools for supporting health care used by health clinicians. Advances in technology and the development of
professionals, authorities, patients and the wider community. e-health have many potential benefits for delivering health
care. It is important, however, that privacy, security and safety
e-health is rapidly evolving and expanding into everyday of care are not compromised. General practitioners need to be
general practice. It has been adopted in primary care from aware of the risks and potential issues involved in some forms
an early stage through electronic patient records, recall of e-health, for example using email – the Medical Council of
systems, prescriptions and patient management systems. New Zealand provides guidance in this area.3
Developments are under way in New Zealand through
the National IT Health Plan2 in partnership with software
providers. This will include a virtual health record, a shared
care record and a national patient portal through which
patients will be able to communicate with their clinicians in
a secure environment.
Furthermore, email, internet and smartphone applications

(‘apps’) have quickly become part of everyday life and
many patients expect health care providers to adopt this
technology. ‘Telehealth’, the direct (e.g. videoconferencing)
or indirect (e.g. website) delivery of health information or
health care is another emerging field of e-health, which may
become more widespread, for example providing care in
rural areas.
1
http://www.who.int/topics/ehealth/en/ Accessed May 2012.
2
National IT Health Board. 2010. The National IT Health Plan. Wellington: National IT Health Board.
3
http://www.mcnz.org.nz

E e-health
Communication
• acknowledge and understand the barriers and • apply safe and effective use of the computer and patient
opportunities computers (and other electronics) can management system (PMS) in the clinical setting
have on the doctor–patient relationship
• recognise the use of video consultation and the • understand the potential changes in day-to-day
implications of this for future televideo consulting communication with patients, acknowledging the impact
of the increase in the use of social networking, text and
email by younger patients.
• describe the differences in electronic forms of

communication compared to face-to-face, and ways
of reducing misinterpretation of information, in particular
through purely electronic communications, such as email
and text
Clinical Expertise
• reflect on the potential risks of information management, • use patient management systems (PMS) and other
including security and privacy issues, and will be familiar electronic systems used in patient care.
with computer security guidelines
• maintain doctor and patient safety

e-health E
Professionalism
• be aware of appropriate and reliable websites for • use search strategies for reliable evidence-based
patient information resources, such as PubMed and Cochrane
• understand and operate the basic booking and • engage in appropriate skill development to keep up
billing systems used in the practice with evolving medical technology and understand that
proficiently using a computer in health care is
independent of medical experience and knowledge
• recognise and appreciate the role of the electronic • acknowledge and describe the role of e-health in
health record in general practice complementing traditional general practice through
better providing information and knowledge
• implement strategies for maintaining the confidentiality • recognise and respect the different attitudes to
of patient data electronic use among patients and health professionals.
• adhere to medico-legal requirements of patient record

management
Scholarship
• maintain clear clinical records and up-to-date • keep abreast of the research and learning opportunities
prescribing information to enable safe use of the shared that exist in e-health.
patient record
• use electronic referral systems, such as eReferral,

eLab and ePrescription
• use electronic strategies in the form of recalls, • understand how an effective information management
reminders and clinical audits to engage in population strategy within a general practice can produce clean
health activities and other preventive health activities data for their use
in their practice
• recognise that e-health has a key role in improving • maximise the use of electronic technology to interact
general practice population health strategies with secondary care and other health services.

E e-health
Management
• use information management skills efficiently and ethically • describe the legal requirements of health records storage
and implement them in the practice
• plan for and use e-health strategies to increase • develop practice policies for documenting email or text
capacity and meet service demands messages received from patients, and the responses
sent back to these patients.


End-of-life Care E
End-of-life Care
End-of-life care is the active total care of
patients and their family/wha-nau at a time
when their disease is no longer responsive to
curative treatments. Control of pain and other
symptoms, addressing the person’s physical,
psychosocial, spiritual and cultural needs
and supporting family, wha-nau and other
caregivers is necessary to provide the best
quality of life for patients and their families.
End-of-life care involves ‘team care’1 and so thorough One of the essential roles of the general practitioner is to
assessment of symptoms and the needs of the patient help patients die with dignity and minimal distress. The
should be undertaken by a multidisciplinary team. The general practitioner must be able to identify such patients
general practitioner has a vital role to play in this team. in the last few months of life and importantly be able to
diagnose the state of dying. It is important that end-of-life
End-of-life care, or palliative care, is defined in and palliative care is culturally appropriate and accessible
New Zealand as: – currently, inequalities in access exist for some groups in
society including Ma-ori and Pacific people.4
Care for people of all ages with a life-limiting illness
which aims to
• Optimise an individual’s quality of life until death by
addressing the person’s physical, psychosocial,
spiritual and cultural needs.
• Support the individual’s family, wha-nau, and other
caregivers where needed, through the illness and
after death.
Palliative care is provided according to an individual’s

need, and may be suitable whether the death is weeks,
months or occasionally even years away. It may be
suitable sometimes when treatments are being given
aimed at improving quality of life.2
1
Palliative Care Council of New Zealand and Cancer Control New Zealand. 2012. Measuring What Matters: Palliative Care. Wellington: Cancer Control New Zealand.
2
Palliative Care Subcommittee and New Zealand Cancer Treatment Working Party. 2007. New Zealand Palliative Care: A Working Definition. Wellington: Ministry of Health.
3
Palliative Care Subcommittee and New Zealand Cancer Treatment Working Party. 2007. New Zealand Palliative Care: A Working Definition. Wellington: Ministry of Health.

E End-of-life Care
Patients value the ongoing input of their general New Zealand general practitioners, in established practice,
practitioner, and this care has been shown to improve the have expressed a desire to deliver palliative medical care
quality of their end-of-life medical care.5 services to their patients and communities. A recent cross-
sectional survey of 168 rural general practitioners showed
Community-based health care is increasingly involved that 98 percent provided palliative care within their patient
in caring for people in their own homes rather than in population and, in the previous twelve months, 7.3 was the
hospitals. General practitioners have a unique role in average number of palliative care patients each had seen.6
coordinating often fragmented community services and
advocating on behalf of the patients, their family/wha-nau General practice training and education for end-of-life care
and carers for community-based end-of-life care. aims to develop the knowledge, skills and attitudes that a
general practitioner will require to work successfully within
a multidisciplinary team.
Communication
• communicate respectfully and sensitively with a patient • appropriately and sensitively discuss any concerns
and their family/wha-nau to reach a working agreement across physical, cultural, psychological, social and
on the nature of any problems, goals of management spiritual domains
and ongoing care
• communicate sensitively with patients and their family/ • maintain a caring and supportive involvement with family/
wha-nau and with the multidisciplinary team of health wha-nau during the bereavement process
professionals involved in the patients’ care
• maintain therapeutic relationships with patients and • be prepared to openly discuss with patients and their
their family/wha-nau based on understanding, confidence, family/wha-nau their desires in relation to the use of
confidentiality, empathy and trust complementary and alternative therapies including
rongoa- Ma-ori.
• sensitively participate in discussions about end-of-life

issues, including grief, breaking bad news and loss, with
patients and their family/wha-nau

• Oncology - Page 115
5
MacKinlay E. Evaluation of a Palliative Care Partnership: a New Zealand solution to the provision of integrated Palliative Care. NZMJ 2007;120(1263):U2745
6
Smyth D. 2010. Palliative Care provision by rural General Practitioners in New Zealand. J Palliat Med Mar;13(3):247-250

End-of-life Care E
Clinical Expertise
• describe the pathophysiology, symptom • provide medical care that is structured around
management, psychosocial and spiritual issues the patients’ and family/wha-nau needs, their level
related to end-of-life care of understanding and their priorities, with the aim of
maximising quality of life, relieving suffering and providing
support
• diagnose dying and activate appropriate care plans, • manage patient care that is specific to their location,
to enable comprehensive care and support for family/ whether that be in their own home, a hospital, a hospice
wha-nau, carers and other health professionals or a residential care facility and identify the special needs
of rural patients
• understand the various components of the experience • understand both the natural history and the role of
of disease from the feelings of the patient, the meaning disease-specific treatments in the management of
and consequences of illness to the patient and their advanced cancer and other progressive life-limiting
family/wha-nau, taking into consideration the Ma-ori health illnesses
models of health care
• gain intravenous access as needed and maintain • practise culturally responsible medicine with an
as required, as well as perform subcutaneous and understanding of personal, historical, contextual, legal
intramuscular injection techniques and social and societal influences.
• make appropriate clinical decisions and manage

24-hour continuity of care through various clinical systems
Professionalism
• provide the highest quality care with integrity, honesty • manage time and resources effectively and balance
and compassion patient care, professional duties, and personal
development and care
• demonstrate an ability to fulfil medical, legal • recognise, respect and preserve patient autonomy
and professional obligations
• manage the personal challenges of maintaining • consider cultural differences that may influence
professional boundaries and personally dealing daily management of end-of-life care.
with death and grief
• reflect on one’s individual practice of medicine to

guide both continuing professional development
and ongoing pursuit of knowledge

E End-of-life Care
Scholarship
• document clear management plans to support • contribute to educating patients, students, health
continuity of care among a multidisciplinary team workers and the community
• develop and maintain an ongoing commitment to the • support developing new knowledge through research.
development of clinical knowledge, skills and experience
• consult effectively with other health professionals, • maintain the proactive and coordinating role for
in particular the local specialist palliative care and general practice
hospice services
• work with other health workers from across the • recognise that in rural communities the general
spectrum of health care to maximise the care given practitioner may need to lead the palliative care team
to patients with appropriate support from distant specialist services.
• advocate for the best level of care for patients in all

settings
Management
• be an effective member of a palliative care team • adopt a critical and evidence-based approach to practice
and maintain this through continuing learning and quality
improvement
• contribute to staff development and training • demonstrate a commitment to professional and

psychological supervision of other members of the
palliative care team
• understand key national guidelines that influence health • put in place mechanisms to ensure self-care, such as
care provision in the locality and region in which they work mentoring and/or peer relationships.

Endocrinology E
Endocrinology
A wide range of conditions related to
hormones and the endocrine glands that
produce them come under the umbrella
of endocrinology and are a significant part
of general practice. Diabetes is one of the
most significant, but from rickets in the
young to osteoporosis in the elderly, PCOS
or menopause, thyroid conditions or obesity,
not only does endocrinology involve a wide
range of glands but a wide range of ages.
The management of these conditions requires a clear Diabetes was also associated with higher neighbourhood
understanding of not only the presentation but also the deprivation and will be a significant factor in health
investigation and management. inequities. ‘Adults living in the most deprived
neighbourhoods (6.2%, 5.2–7.3 in NZDep2006 quintile
One of the most significant conditions affecting our 5) were more than twice as likely to be diagnosed with
communities is diabetes. The lifestyle factors that diabetes than adults in the least deprived neighbourhoods
predispose to this, as well as the significant morbidity (2.7%, 1.9–3.6 in NZDep2006 quintile 1), adjusted for
associated with the condition, are an essential focus of age’.1 It is, however, estimated that only half of those with
general practice. diabetes have been diagnosed.2
The most recent New Zealand health survey revealed that

one in twenty adults had doctor-diagnosed diabetes and
this rose to one in seven among those over 65 years. The
prevalence of diabetes in Ma-ori, Asian and, in particular,
Pacific populations exceeds that in the overall population.
1
http://www.health.govt.nz/publication/portrait-health-key-results-2006-07-new-zealand-health-survey
2
http://dhbrf.hrc.govt.nz/media/documents_abcc/ABCC_Study_NZ_Literature_Review_2011.pdf

E Endocrinology
The significance of diabetes within the New Zealand health Endocrinology has many chronic conditions that need
system is illustrated by including ‘More Diabetes and Heart ongoing management, but there are acute presentations
Checks’3 as one of the Government’s six health targets. also. Although not frequent, the first line treatment
Diabetes places a significant economic burden on the health of the four most prevalent endocrine emergencies
system and this is expected to increase.4 The personal cost (diabetic ketoacidosis, adrenal crisis, thyrotoxic storm
of this disease, with its effects on the heart, blood vessels, or myxoedema coma) in rural areas is usually managed
eyes, kidneys and nerves, are also significant. by the general practitioner or rural hospital team. A good
understanding of the presentation, investigation and
treatment of these is essential to any comprehensively
trained generalist.
Communication
• take a comprehensive history • consider health literacy when discussing conditions and
treatments with patients and communicate at the patient’s
level of understanding
• establish rapport with the patient and communicate • understand the causes of non-compliance and work on
succinctly and with empathy the implications of possible ways with the patient to reduce the consequences of this
outcomes related to chronic endocrine conditions
• describe the lifestyle changes required for patients with • take a person-centred approach, coming to a mutual
diabetes and other chronic conditions and discuss these decision about ongoing management and care.
in a motivational interviewing style

• Cardiovascular - Page 42
3
http://www.health.govt.nz/new-zealand-health-system/health-targets/2011-12-health-targets/health-targets-better-diabetes-and-cardiovascular-services-more-heart-
and-diabetes-checks
4
http://www.health.govt.nz/publication/report-new-zealand-cost-illness-studies-long-term-conditions

Endocrinology E
Clinical Expertise
• recognise early presentations of the variety of • recognise a variety of more unusual endocrine
endocrine conditions seen in general practice, and presentations exemplified by, but not limited to,
elicit a history relating to these Addison’s disease, ambiguous genitalia, abnormal
stature and errors of metabolism
• develop and maintain a knowledge of the tests and • keep comprehensive notes that enhance shared care
investigations required
• demonstrate and negotiate appropriate management • recognise normal development through puberty and
plans based on the results of investigations identify abnormalities
• investigate, treat and refer when appropriate for endocrine • recognise significant or urgent presentations that require
conditions, such as osteoporosis, polycystic ovaries, immediate referral or expert opinion
thyroid conditions
• prescribe oral medications for diabetes accurately, • discuss the implications of diabetes in pre-pregnancy
as well as demonstrate competence in starting insulin counselling as well as throughout pregnancy
• discuss the side effects, both minor and major, of • discuss the various endocrine conditions that have an
medications used when prescribing for endocrine impact on fertility
conditions
• discuss all the factors that influence obesity and • familiarise themselves with the challenges of living
use strategies with patients to reduce or mitigate with a chronic condition and how this might impact
against these on patient care.
Professionalism
• discuss Medic Alert and emergency access for • discuss ways of ensuring systems are in place
patients with significant endocrine conditions so that tests are appropriately followed up.

E Endocrinology
Scholarship
• write a comprehensive referral to appropriate • undertake an audit of their practice to ensure

secondary services optimum treatment and assessment for diabetes
• develop their skills, increasing their ability to manage • keep up to date with emerging treatments for
diabetes and other endocrine conditions in the endocrine conditions.
community
• work with local community-based diabetes health • work with the practice team to enhance the overall
professionals wellbeing of the community in relation to the lifestyle
risks of diabetes
• record screening of the practice population for diabetes • communicate with allied health professionals involved
and have a working knowledge of the ways that with care of patients with chronic endocrine conditions
screening is being implemented
• encourage patients with chronic endocrine conditions • communicate with team members and emergency
into appropriate work if possible and advocate for them services when dealing with an endocrine emergency.
as required
Management
• review practice programmes run by the practice team • identify financial implications for both patients and the
and work together to enhance these processes for practice of long-term condition management
patients’ benefit
• undertake and encourage education in endocrine-related • encourage education and training of staff to work at the
conditions top of their scope in endocrine conditions, particularly
diabetes.

Ear, Nose and Throat E
Ear, Nose and Throat

There is probably not one day goes by in
general practice where general practitioners
do not have to look in an ear, up a nose
or into a throat. From infection to foreign
body, the ability to competently examine
these areas and treat any known causes is
essential to daily practice.
Sore throat is among the top ten symptoms that patients Hearing loss affects up to 17 percent of the population
present to their general practitioner in New Zealand.1 The and is significantly more prevalent among Ma-ori and
recognition and treatment of acute sore throats is essential Pacific peoples.5 In 2010 there were 180 new deafness
in preventing rheumatic heart disease and reduction in notifications made6 that met the following criteria: children
health inequalities in this area. New Zealand has high rates and young people 18 years or younger with an average
of acute rheumatic fever (ARF) and rheumatic heart disease hearing loss of 26dBHL or greater over four audiometric
(RHD), setting it apart from most other developed countries. frequencies (0.5, 1.0, 2.0 and 4.0 kHz) in one or both ears,
Ma-ori and Pacific peoples are particularly at risk,2 with including those who are born outside New Zealand. The
Pacific peoples having the highest rate of rheumatic fever communication skills when dealing with those who are deaf
in New Zealand and one of the highest rates in the world.3 requires particular attention. Sometimes these patients also
Managing sore throats appropriately within primary care require a general practitioner to provide an advocacy role.
is key to reducing health inequities in this area. The Sore Ma-ori deaf people constitute a large proportion of the deaf
Throat Guideline in the Primary Care Handbook provides community in New Zealand. If services specific to Ma-ori
more information.4 are available, Ma-ori deaf people may prefer to access these
services through a sign language interpreter.
General practitioners should have skills to assess the

ear, nose and throat thoroughly and provide appropriate
treatment, advice and referral for common acute or chronic
conditions and recognise the red flags.
1
McAvoy B, Davis P, Raymont A, Gribben B. 1994. The Waikato Medical Care (WaiMedCa) Survey 1991-1992. NZ Med J. 1994;107:388–433; and Squires I, Bird J,
Elliot J, et al. PRIMEDCA. North Canterbury General Practice. Clinical caseloads: an overview of content and management. Christchurch: Research Committee,
Canterbury Faculty, RNZCGP; 1979.
2
White H, Walsh W, Brown A et al. Rheumatic Heart Disease in Indigenous Populations. 2010. Heart Lung Cir 2010;19:273-81.
3
ESR. 2009. Public Health Surveillance. Notifiable and Other Diseases in New Zealand. Annual Surveillance Report. Available from www.surv.esr.cri.nz Accessed Oct, 2010.
4
New Zealand Guidelines Group. 2012. New Zealand Primary Care Handbook 2012. 3rd ed. Wellington: New Zealand Guidelines Group.
5
The National Foundation for the Deaf. Australia and New Zealand Hearing Loss Statistics. Available at: http://www.nfd.org.nz Accessed April 2012.
6
Digby JE, Kelly AS, Purdy SC. 2011. Hearing Loss in New Zealand Children: 2010, New Zealand
Audiological Society, Auckland, New Zealand.

E Ear, Nose and Throat
Communication
• maintain a person-centred approach when working • consider appropriate communication and show sensitivity
with patients, their family/wha-nau and/or interpreters when examining the heads of Ma-ori patients.
• understand the barriers faced by our deaf community in

obtaining health care and demonstrate the advocacy skills
required to reduce inequalities in access
Clinical Expertise
• understand allergic conditions, their investigation and • use the correct examination skills required for assessing
management, acutely and long term a variety of ear-related conditions, such as vertigo and
hearing loss
• discuss dental health and its management in both • understand acute emergency treatment and chronic care
children and adults management of a variety of ear, nose and throat
conditions, such as sleep apnoea, sinusitis, epistaxis and
otitis media
• investigate and manage sore throats, including reducing • understand and manage particular risks and treatments
the incidence of progression to rheumatic heart disease, of epistaxis, recognising the peculiarities of managing this
thereby reducing health inequalities in an isolated area
• take anatomical and physiological considerations into • share their understanding and knowledge about possible
account when examining the ear, nose and throat interventions for hearing loss patients, such as hearing
aids and cochlear implants
• assess, investigate and treat throat and neck • apply knowledge of local laboratory requirements for tests
presentations, such as lump in the neck and hoarseness and interpret test results.
of voice


Ear, Nose and Throat E
Professionalism
• apply an informed consent process for ENT procedures in • discuss the advocacy role that may be required when
general practice caring for deaf or hearing-impaired patients.
• comply with evidence-based protocols for sterilising and

maintaining equipment used in examining ENT conditions
Scholarship
• undertake audit and evaluation of hearing screening • research and evaluate the incidence of sore throat and
uptake in the newborn and children in the practice rheumatic fever in the practice population and initiate
population programmes to reduce inequalities in at-risk populations.
• undertake ongoing professional development in ENT

procedures
• formulate a list of the range of services available for • engage with allied health professionals involved in ENT
hearing impaired patients both locally and nationally, care, investigation and management.
including those particularly catering for the Ma-ori and
Pacific deaf communities
Management
• review and keep up-to-date practice protocols for ear, • establish and review policy on standing orders for ENT
nose and throat procedures procedures performed in the general practice setting.

E Eyes
Eyes
Conditions involving the eye vary between
totally mild to extremely serious often with
similar presentations. Some conditions
may cause blindness; this can include
glaucoma, temporal arteritis, cataracts or
macular degeneration among others. The
awareness of the symptoms related to
these conditions, preventable causes and
the management of these is essential to
general practice.
The most recent Disability Survey conducted by Statistics The increasing incidence of diabetes will also contribute
New Zealand in 2006 found a total of 71,100 people in to poor health outcomes in relation to eye disease and
New Zealand with sight loss, including 11,400 children especially in populations at risk. This will include Ma-ori
and 59,700 adults.1 Ma-ori experience higher rates of sight and Pacific populations, where the prevalence of diabetes
loss – one study estimated that in 2009, around 12,000 is around three times higher than among other New
Ma-ori people had sight loss, and more than 600 were Zealanders. Prevalence is also high among South Asian
blind.2 Rates of sight loss will increase as New Zealand’s populations.4 The contribution of primary care in managing
population ages, with some studies estimating that, by diabetes, and reducing the eye-related morbidity because
2020, the number of people aged 40 years or over with of it, is significant.
vision loss may rise to nearly 174,000, including almost
19,000 Ma-ori people with sight loss.3 A general practitioner should have the skills to thoroughly
examine the eye, diagnose significant conditions and
provide appropriate referral and, when necessary, perform
eye-related procedures within their scope. The skills
required may differ within the general practice setting a
general practitioner works in.
1
Office for Disability Issues and Statistics New Zealand. 2009. Disability and informal care in New Zealand in 2006: Results from the New Zealand Disability Survey, report
for Statistics New Zealand, Wellington.
2
Access Economics for VISION 2020 New Zealand and VISION 2020 Australia. 2010. Clear Focus: the Economic Impact of vision loss in New Zealand 2009. Canberra:
Access Economics.
3
Access Economics for VISION 2020 New Zealand and VISION 2020 Australia. 2010. Clear Focus: the Economic Impact of vision loss in New Zealand 2009. Canberra:
Access Economics.
4
http://www.health.govt.nz/our-work/diseases-and-conditions/diabetes/about-diabetes Accessed April 2012.

Eyes E
Communication
• clearly convey urgency in communications with • describe the eye examination process clearly
patients and specialist staff where there is an to the patient, their family/wha-nau or carers.
eye-related emergency
Clinical Expertise
• examine the eye and take an ophthalmic history • deal with a foreign body in the eye, its removal and
appropriate follow-up
• identify urgent eye conditions that require referral • assess and examine infants for common eye conditions.
• prescribe a variety of treatments for eye conditions,

recognising risks and benefits
Professionalism
• consider the emotional impact and disabilities • ensure competence in skills and knowledge by
associated with loss of vision and take this into account participation in ongoing professional development in eye-
within consultations related conditions and treatment.
• allow appropriate time for discussion and negotiation

of both examination and management of eye-related
conditions

E Eyes
Scholarship
• document carefully eye-related accidents, especially • audit practice data on uptake of retinopathy screening
foreign bodies, and consider possible morbidity and work on strategies to improve this and pursue
associated with these continuous quality improvement.
• undertake further training in eye-related presentations

and examinations, such as skills in slit lamp use in the
rural community
• develop awareness of at-risk groups in the community • establish effective working relationships with local
in relation to access to eye health resources and work ophthalmologists and optometrists
towards reducing this inequality, such as in Ma-ori and
Pacific populations
• document and refer to providers who perform retinal • consider the impact of reduced access to screening
screening in the local area and investigate ways to improve this in the practice
population, especially for at-risk groups.
Management
• review management of practice policy on recalls and • ensure there is a safe practice environment for patients
how to improve outcomes in retinal screening who are visually impaired.

• Long-term Conditions – Page 85

Family Violence F
Family Violence
Family violence is common and is a
serious social issue in New Zealand
affecting all ages from children to older
people, cultures, geographical areas
and socioeconomic groups. It leads to
significant health issues, both physical and
psychological for the person being abused
and the family/wha-nau around them.
About half the homicides and 58 percent of reported crimes In 2006 the Taskforce for Action on Violence within Families2
in New Zealand are family violence-related. However, stated, ‘All families and wha-nau should have healthy, respectful,
although police attend a domestic violence callout every six stable relationships, free from violence.’ The Taskforce is taking
minutes, it is estimated that only 20 percent of episodes are action on four fronts to achieve its vision:
actually reported.1
• Leadership – we need leadership at all levels if we are going
The general practitioner is often the key health professional to transform our society into one that does not tolerate
associated with a family/wha-nau. Being alert to the risk of family violence
family violence and being willing to discuss this in a safe,
• Changing attitudes and behaviour – we have to reduce
confidential and open way may have a significant impact on
society’s tolerance of violence and change people’s damaging
the management and health outcomes of those affected.
behaviour within families
It may also impact on the general practitioner’s ability to • Safety and accountability – swift and unambiguous action
offer help to those who perpetrate the abuse, should they by safe family members and the justice sector increases
disclose their activity or the general practitioner becomes the chances of people being safe and of holding perpetrators
aware of it. Recognising the various supportive and to account
preventive factors that reduce the risk of family violence is
essential to the general practitioner. • Effective support services – individuals and families affected
by family violence need help and support from all of us so
they can recover and thrive
1
http://www.areyouok.org.nz/files/statistics/ItsnotOK_recent_family_violence_stats.pdf (accessed April 2012)
2
http://www.msd.govt.nz/documents/about-msd-and-our-work/work-programmes/initiatives/action-family-violence/taskforce-report-first-report-action-on-violence.pdf
3
Fanslow and Robinson E. 2004. Violence against Women in New Zealand: Prevalence and health consequences New Zealand Medical Journal 117
4
See Balzer R, Haimona D, Henare M, Matchitt V. 1997. Ma-ori Family Violence In Aotearoa, A Report Prepared for Te Puni Ko-kiri, Wellington; Lievore, Denise and
Mayhew, Pat (with assistance from Elaine Mossman). 2007. The Scale and Nature of Family Violence in New Zealand: A Review and Evaluation of Knowledge: Crime
and Justice Research Centre & Centre for Social Research and Evaluation, Victoria University of Wellington; Erai M, Pitama W, Allen E, Pou N. 2007.
http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/research/scale-nature-family-violence/
5
Ministry of Social Development. 2011. Every Child Thrives, Belongs, Achieves. Wellington: Ministry of Social Development.
6
Snively. 1996. The New Zealand Economic Cost of Family Violence.

F Family Violence
There are certain population groups in society who are more There is a significant health and social cost to family
vulnerable than others, for example: violence – the cost of domestic violence in New Zealand
has been estimated to be between $1.2 and $5.8 billion
• between 33 and 39 percent of New Zealand women per annum.6 Transforming and reducing domestic violence
experience physical or sexual violence from an intimate statistics in a community takes the whole community,
partner in their lifetime3 and the general practitioner, as a leader in their practice
population, has a vital role to play.
• Ma-ori are substantially over-represented as both victims and
perpetrators of domestic violence4
• 47,374 children aged 0–16 were present, or usually residing

with the victim, at an incident of family violence reported to
the police in 2010.
Communication
• use appropriate communication skills to safely • acknowledge patient concerns when discussing
screen for family violence in the context of a general removal of a child/children from a situation of
practice consultation family violence
• use appropriate communication skills to clearly • adopt a non-judgemental approach when dealing
describe power and control aspects of family violence with disclosure of family violence.
Clinical Expertise
• describe common injury patterns associated with • take a history and perform a physical examination
family violence relevant to the presenting problem with particular
attention to accurate documentation
• recognise child abuse and help manage and prevent it • be able to access and understand the usefulness of body
diagram sheets
• recognise the influence of the family/wha-nau on • make valid and timely decisions about treatment,
prevention, presentation and management of childhood referral and follow-up of child abuse and neglect, and
and adult injury options for management referral and follow-up of partner
or family/wha-nau abuse.
• understand the need for safety planning, and the risks

and dangers associated with partner violence

Family Violence F
Professionalism
• resist investigating abuse but demonstrate ease in • assess family violence in a way that recognises the
asking, assessing and advising of support importance of involving the whole practice team, the
level of confidentiality required, and the need to provide
support to staff following a disclosure of abuse
• work according to clinician reporting requirements for • consider their own beliefs and cultural issues when
suspected child abuse or neglect dealing with family violence
• understand the value of sensitively and proactively • discuss the ethical issues related to reporting family
raising the issue of abuse violence
• know and implement the practice policy for prevention and • take into account that the presence of certain family/
intervention in family violence wha-nau members in the consulting room may influence
the likelihood of disclosure occurring.
Scholarship
• describe the burden of family violence in New Zealand • discuss the links between family violence, historical
in relation to the local region, the country as a whole inequalities and the inequalities of health suffered by Ma-ori
and different ethnic groups
• discuss the medical consequences and disabilities • document verbatim the history and findings on the
of all types caused as a direct result of family violence physical examination so that notes are reliable should
to individuals, families and communities they be needed for any legal purpose in the future.

F Family Violence
• collate a list of local and national agencies, including • describe the advocacy role of the practice team and
Ma-ori agencies, that can help manage a family doctor for victims of family violence
violence case
• collaborate with local services and undertake training on • describe and understand the function of local Sexual
managing family violence Assault Assessment and Treatment Services (SAATS),
including police and Doctors for Sexual Abuse Care-
trained doctors
• understand medico-legal issues relating to abuse and the • recognise and identify resources and techniques to help
need for clear documentation for use in court proceedings patients experiencing family violence.
Management
• help members of the practice team deal with domestic • implement well-researched and practical policies within
violence their organisation or practice for family violence issues
and the inequalities in relation to Ma-ori and other
high-risk groups
• understand the function of local and national specialist • collaborate with the multidisciplinary team and community
family violence services that can help deal with and services in ensuring optimal care of the patient, including
manage family violence appropriate management and follow-up.
• understand the local clinical pathways and key personnel

who deal with domestic violence in the region

• Adolescent/Rangatahi/Youth Health
- Page 38
- Page 119

Gastroenterology G
Gastroenterology
A general practitioner should have a
broad knowledge of conditions of the
gastrointestinal tract – mouth to anus –
and manage these competently. They
should not only demonstrate an in-depth
knowledge of the common conditions but
also have an awareness of the more rare
presentations so that they can correctly
place them in their differential diagnosis.
Bowel cancer is the second highest cause of cancer death Patients presenting with acute abdominal pain, which
in New Zealand,1 but it can be treated successfully if it is may be caused by appendicitis, cholecystitis, pancreatitis
detected and treated early. The general practitioner has an or other conditions, requires experience in recognition of
essential role in this early detection. The Ministry of Health symptoms, targeted investigation and often immediate
is currently undertaking a four-year pilot that started in 2011 referral by the general practitioner.
to look at models of screening for bowel cancer and how
this would work on a population basis.2 When working in a rural setting, the general practitioner
needs to be able to work more independently in an
Until the evaluation of this pilot is completed, a national extended general practice role. They need to provide safe
programme will continue to be on the horizon, but general and effective management of acute presentations and
practitioners still need to be vigilant about detecting and timely transfer for those patients who require referrals to
referring as early as possible. It is essential that general specialist services or admission to base hospital.
practitioners are aware of the risk factors3,4 and know the
best evidence behind investigation and referral. Despite
a reduction in the overall excess in mortality rates with
colorectal cancer over the period 1991 to 2004, Ma-ori
continue to have higher mortality rates than non-Ma-ori.
1
http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/bowel-cancer-programme/about-bowel-cancer
2
http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/bowel-cancer-programme/bowel-screening-pilot
3
http://ebooks.nzgg.org.nz/suspected_cancer_guideline/
4
http://crct.org.nz/downloads/NZ_CRC_report.pdf

G Gastroenterology
Gastroenterology can also cover liver and pancreatic Additionally, inflammatory bowel disease, irritable bowel
disease. The various forms of hepatitis, and in particular syndrome, gastro-oesophageal reflux disease, coeliac
hepatitis B, are often first diagnosed in general practice. disease and the various other gastrointestinal diseases all
Chronic hepatitis B remains more common in Ma-ori, present to the general practitioner initially and need to be
Pacific and Asian adults and will continue to be a risk investigated thoroughly and treated appropriately. A wide
for immigrants and those who have not had hepatitis knowledge of these conditions, skills in both communication
B immunisation as children. Early detection (screening, and examination and an open-minded attitude to the often
diagnosis, risk assessment) advice for patients about multiple consultations that may be required are essential to
lifestyle, screening and immunisation of partners and family/ managing these long-term conditions.
wha-nau, continuing surveillance and appropriate referral are
important to prevent cirrhosis and primary liver cancer.
Communication
• take a comprehensive history related to change in • use recognised communication skills techniques when
bowel habit and negotiate appropriate management breaking bad news
• describe the results of investigations to patients • elicit the ideas, concerns and expectations of a patient
presenting with gut-related symptoms
• describe physical examination findings to patients • manage long-term conditions, maintaining ongoing
and their family/wha-nau or carers communication with patients their family/wha-nau and
other health professionals involved in care.
Clinical Expertise
• determine a differential diagnosis for a variety of upper • use practice-based equipment available for investigating
and lower gastrointestinal symptoms bowel symptoms, such as a proctoscope
• perform a comprehensive, condition-appropriate • prescribe appropriate medications for gastrointestinal

abdominal examination conditions that present in general practice
• apply knowledge of symptoms and signs of bowel cancer, • discuss the impact of gastrointestinal conditions on
recognition of red flags, investigations and referral nutrition and, conversely, the impact of nutrition on the gut.
• manage sub-acute bowel obstruction conservatively but

appropriately to the rurality of the setting with appropriate
subsequent follow-up and investigation

Gastroenterology G
Professionalism
• consider ways to reduce inequalities in outcome for • discuss patient safety issues when performing
Ma-ori presenting with gut-related symptoms, such as procedures such as sigmoidoscopy, for example
late presentation with bowel cancer maintenance of equipment, use of chaperones and
informed consent.
• work within their own scope of practice but also

establish links with those who can help further their skills
Scholarship
• audit management of long-term conditions in the • seek out relevant continuing professional development
general practice setting activities that will further their knowledge and skills, such
as endoscopy training
• monitor use of investigations, such as scans and blood • write comprehensive and informative referrals and reports
tests, considering resource use for the practice population as required.
as a whole
• identify the various bowel cancer-related services • communicate with other health care providers involved
available both locally and nationally and know referral in the care of patients with gut-related conditions, such as
pathways to these stoma nurses
• work with local health professionals involved in the care • manage acute conditions in both the urban and rural
of patients with long-term gut-related conditions setting involving a team approach and communication
with other specialists, transport teams and support staff
as appropriate.
• discuss available services for patients with long-term

conditions

G Gastroenterology
Management
• use their knowledge of local resources available to • work with practice and allied health professionals
manage critical conditions and establish relationships to up-skill in areas of community need in relation to
in conjunction with the practice team gastrointestinal conditions
• institute screening programmes relevant to • be aware of the reporting requirements and protocols
gastrointestinal conditions with reference to either local around notifiable gastrointestinal diseases and how this is
or national guidelines managed in the practice.

• Adolescence/Rangatahi/Youth Health
- Page 38
- Page 119

Genetics G
Genetics
With the mapping of the human genome,
advances in genetic medicine have been
significant and it is likely that the role
of the general practitioner will expand
to detecting and managing genetic
conditions.1
Knowledge of the various genetic causes of conditions, While not specifically genetically predetermined, families
such as cystic fibrosis, and stem cell treatments for various can have a history of congenital conditions and the general
cancers have raised public awareness of genetics. The practitioner needs to be able to provide support and
relevance of genetics to disease is an expanding field that appropriate care.
the general practitioner is required to know about.
For example, in New Zealand congenital birth defects,
Genetics in general practice involves managing diseases including common problems such as cleft palate, heart
that run in families/wha-nau. Essentially all diseases and defects and dislocation of the hips, affect about one in
conditions are said to have a genetic component. For every every 30 children.5
10 patients that we see, one of them will have a genetic
component to their illness.2 The management of genetic The impact of genetics in the context of general practice
diseases and conditions involves both the individual and is determining the allocation of the health dollar in New
their family/wha-nau members. Zealand and across the world. It is also having an impact
on individual consultations in the primary care setting.
Many of the common cancers have a genetic component.
Colorectal cancer, one of the most common cancers in The general practitioner requires skills in all domains to be
New Zealand, is currently being examined to determine the able to help patients deal with the vast array of information
clinical behaviour of the cancer.3 that is available publicly and advise on what is best practice
for their particular situation.
Recent studies suggest that genetic factors are involved
with developing diabetes, with first-degree relatives having
a higher risk than unrelated individuals from the general
population.4 Using family history as a way of recognising
risk factors for Ma-ori is a way that the health inequalities
between Ma-ori and non-Ma-ori may be improved.
1
Royal College of General Practitioners. 1998. Genetics in Primary Care: a report from the RCGP North West England Faculty Genetics Group. Occasional Paper 77.
London: RCGP
2
Hopkinson I. Clinical context of genetics in primary care. 2004. Presentation at: Reality not Hype: the new genetics in primary care. www.londonideas.org
3
http://www.hrc.govt.nz
4
http://www.who.int/genomics/about/Diabetis-fin.pdf
5
http://www.hrc.govt.nz/sites/default/files/HRC59%20(Robertson)%20(2).pdf

G Genetics
Communication
• communicate genetic risk to patients and describe the • explore family relationships, including issues around
difference between testing and screening, for example adoption and paternity
antenatal screening for genetic conditions
• explain the implications of common genetic conditions • support family/wha-nau through clinical uncertainty in the
to an individual and their family/wha-nau process of diagnosis or when there is no diagnosis.
• inform patients and their family/wha-nau about genetic

risks, but encourage them to make their own choices
and support their decision
Clinical Expertise
• describe how genetics underpin a variety of illnesses • understand the implications of genetic conditions on
and conditions other family members
• draw a genetic family tree • discuss with families the role of genetic screening in
relation to developmental delay or disability
• manage, monitor and screen for genetic disease in • work within their limits of competency with regard to
their community, taking into account particularly at-risk genetic screening and counselling
populations or families
• incorporate emerging genetic screening into their practice • understand and follow the standard genetic testing
processes as detailed by national genetic services
• describe the parameters of screening tests and what they • maintain confidential records of genetic testing, genetic
mean, referring to regional services appropriately risk and potential familial conditions.

Genetics G
Professionalism
• recognise when their own attitudes, values and beliefs • advocate for patient and family/wha-nau access to allied
might impact on patient care when discussing the health professional services and resources, including
implications of genetically inherited conditions and support groups
maintain a professional approach
• foster inter-professional relationships to enable them to • understand the emotional impact on patients and family/
deal with common genetic disorders in their communities wha-nau of genetic diagnosis.
• understand the ethical issues surrounding disclosure

of information in relation to genetic risk to other family
members or other third parties
Scholarship
• maintain up-to-date clinical knowledge of the pathology • describe the implications of genetic disease in different
and clinical issues associated with common genetic ethnic and religious cultures.
diagnoses
• recognise that genetic risk may be viewed differently • engage with local genetic services and enable access to
in family/wha-nau-based cultures genetic counselling in isolated or rural areas.
• explain how they use local and national support services

and other members of the primary care team to care for
patients and families with genetic disorders
Management
• educate their practice team about genetic diseases and • describe relevant genetic screening and implementation
their management with particular emphasis on ethical, within the practice.
legal and social implications
This curriculum statement links with all others in the series.

G Health and Work
Health and Work

Good work is good for health and
wellbeing – it may encourage physical
activity, it provides a sense of community,
it reduces poverty and social exclusion
and aids recovery from illness and injury.
Conversely, unemployment has a negative
impact on physical and mental health for
the individual and their dependent family/
wha-nau members.
The importance of the health benefits of work has been There are many health conditions that a general practitioner
reinforced by recent international research exploring the needs to be aware of that may relate to work exposures.
subject. It has been acknowledged as relevant in New These include well-known occupational diseases, such
Zealand by Government, employers, unions, insurers and as the asbestos lung diseases, occupational asthma and
health care providers and their professional bodies.1,2,3,4 zoonoses, which are encountered by a general practitioner
occasionally. However, most health conditions and many
A worker’s environment can impact on their health, for treatments prescribed have the potential to impact on a
example noise-induced hearing loss, and also the impact person’s capacity to work.
of health on work, for example working with a disability.
Not a day goes by in general practice that you do not see Awareness of a patient’s work environment, interactions
a worker, someone who could be working or people who and exposures can be critical to providing quality health
have had work influence their health. General practitioners, care and may avoid needless disability. Initial enquiry may
in partnership with patients and their family/wha-nau, should be as simple as asking ‘what do you do at work?’
weigh up the risks and benefits of being in work, being in
work with modifications or being off work.
1
Black, C. 2008. Working for a healthier tomorrow: Dame Carol Black’s review of the health of Britain’s working age population. Norwich: The Stationery Office.
2
Waddell G, Burton A. 2006. Is work good for your health and well-being? London, UK: The Stationery Office.
3
Australasian Faculty of Occupational & Environmental Medicine. New Zealand Consensus statement on the health benefits of work. Royal Australasian College of
Physicians. http://www.racp.edu.au/index.cfm?objectid=57063EA7-0A13-1AB6-E0CA75D0CB353BA8
4
Australasian Faculty of Occupational & Environmental Medicine. Position Statement on the Health Benefits of Work. The Royal Australasian College of Physicians.
http://www.racp.edu.au/index.cfm?objectid=F07790EC-0F2D-D1EB-4298E5D44500162A
5
PricewaterhouseCoopers. 2008. Accident Compensation Corporation New Zealand Scheme Review. Wellington.
6
NZ Statistics, 2006. 2012. Ministry of Social Development, Wellington.
7
Office of the Auditor General. 2011. Public entities’ progress in implementing the Auditor-General’s recommendations Chapter 6. Wellington: Office of the Auditor General.

Health and Work H
Inequality persists. In New Zealand, Ma-ori suffer from A call to action on all fronts by all stakeholders is needed.
cardiovascular disease, mental health issues and To not take heed of this body of evidence is to put many
respiratory disease at disproportionate levels compared individuals, families and communities at risk of the well
to non-Ma-ori. These are all conditions associated with documented health consequences of worklessness.
unemployment.4 It is known that a higher proportion of Dr Kevin Morris, Director Clinical Services, ACC
New Zealand’s Ma-ori working age population experience
disability than European New Zealanders and an increase General practitioners have a critical role when assessing
in this disparity occurs with age.5 Working-age Ma-ori fitness for work, as the opinion communicated will influence
have three times the chance of being long-term welfare outcomes. The ability to consider carefully whether a
beneficiaries (on benefits over 12 months) compared with medical condition necessitates time off work and identifying
working-age non-Ma-ori.6 where adaptation or accommodation may be more
appropriate in patient recovery is important if the health
Between December 2008 and December 2010 the number benefits of work are to be achieved.
of unemployed doubled, at the same time sickness and
invalid beneficiaries increased by 17 percent and 2 percent
respectively. In June 2010 about 58,000 New Zealanders
were receiving the sickness benefit and 85,000 the
invalid’s benefit. An audit was undertaken by the Ministry
of Social Development in October 2009 and a subsequent
programme of work was established called Future Focus.
This aimed to gather more information about a person’s
capacity for work, and provide comprehensive case
management and ongoing monitoring of these initiatives.7
Communication
• communicate appropriately with patients, including • communicate their knowledge of relevant legislation
obtaining consent, history-taking, discussing findings to patients
and negotiating a management plan
• communicate risk to patients, carers and their family/ • employ communication skills when breaking bad news
wha-nau and describe the processes that might facilitate this
• develop an awareness of and show the ability to complete • discuss the communication skills needed for dealing
certification documents to communicate opinion accurately with conflict or adverse outcomes.
• discuss the specific requirements and ethics behind

notifying other authorities

H Health and Work
Clinical Expertise
• take an accurate occupational history • develop and maintain up-to-date knowledge of the
impact of worklessness on health
• conduct appropriate physical examination • describe the impact of long-term health conditions on
work capacity and interventions for minimising disability
• develop a differential diagnosis and arrange appropriate • describe the biopsychosocial model of illness and disease
investigations and the relevance of this in assessing fitness for work
• investigate health complaints that may relate to work or • describe common or important occupational diseases,
environmental exposure their treatment and potential long-term impact
• describe the utility and general principles of workplace • outline the various local workplaces in the region and the
assessment potential impact these might have both on health and the
ability to employ staff with health issues
• define the potential health effects of common and • describe the principles of rehabilitation relating to physical,
important workplace hazards psychological, social, recreational and cultural needs.
• assess fitness to work and develop a return-to-work plan
Professionalism
• reflect on the professional and personal boundary • describe the aspects of personal safety that may be
issues encountered when working in a rural community required when dealing with conflict
• describe ways of supporting their own occupational • identify their own workplace risks and harms
health and wellbeing, including that of their family/wha-nau
• be aware of legal and ethical boundaries when • identify when to seek advice or refer and undertake this
communicating medical information to a third party, such appropriately and expediently
as a union, employers or insurers
• explain their role in relation to patients and agencies • explore the role of medicine as a profession in the context
related to work of wider personal life experience and life goals.

Health and Work H
Scholarship
• write appropriate certificates and referrals relating • undertake personal reflection and develop a focus for
to occupational conditions or events ongoing learning, audit or research
• keep comprehensive notes relating to workplace • undertake further training and education to develop
accidents and diseases specific expertise in this subject.
• maintain a comprehensive knowledge of the

developments in health and work-related conditions
• update continually their knowledge of ACC, Work and • refer to the appropriate local agencies that can help
Income, the Department of Labour and other government with assessment, treatment and ongoing management
agencies and their particular areas of involvement with of work-related conditions
work-related conditions
• describe ways of supporting Ma-ori in their workplace and • develop a working relationship with local employers, and
back into work, reducing inequities that will have an case managers from Work and Income, ACC and other
impact on health outcomes work-related entities
• describe the various workplace mechanisms available to • consider the impact and implications of worklessness on
support employees family/wha-nau and schooling.

H Health and Work
Management
• describe the protocols and reporting systems for • understand the financial implications of signing people
maintaining and monitoring safety in their own practice off work for the individual, their family/wha-nau and the
country
• update continually their knowledge of health and safety • take a leadership role in developing a practice protocol
legislation compliance and its relevance to the general for supporting people back into work to help improve
practitioner as an employer health outcomes.
• describe hazards and risks of medical work and how

to reduce these in your practice team

- Page 38

Long-term Conditions L
Long-term Conditions
Long-term, or chronic, conditions as they
are often called, are defined by the World
Health Organization as having one or
more of the following characteristics: they
are permanent, leave residual disability,
are caused by nonreversible pathological
alteration, require special training of
the patient for rehabilitation, or may be
expected to require a long period of
supervision and care.1
The New Zealand National Health Committee (NHC) in 2007 Primary care has an increasingly important role in long-
defined a chronic condition as any ongoing, long-term or term condition management with the move to provide
recurring condition that can have a significant impact on services closer to home and, in particular, to shift services
people’s lives.2 from secondary to primary care. This is a key part of the
Government’s policy. ‘Primary health care has a part to
Long-term conditions (LTC) and their management place a play in helping reduce acute demand pressure on hospitals
significant burden on health services in New Zealand. ‘Two by better managing chronic conditions and proactively
in every three New Zealand adults have been diagnosed with supporting high need populations.’5
at least one long-term condition and long-term conditions
are the leading driver of health inequalities.’3 Long-term
conditions account for more than 80 percent of deaths.4
1
WHO. 2005. Preventing Chronic Disease: A vital assessment. Geneva: World Health Organization.
2
http://www.nhc.health.govt.nz/resources/publications/meeting-needs-people-chronic-conditions
3
Ministry of Health. 2008b. A Portrait of Health. Key Results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health cited in http://www.health.govt.nz/
publication/report-new-zealand-cost-illness-studies-long-term-conditions
4
National Health Committee. 2007. Meeting the Needs of People with Chronic Conditions: Ha-pai te Wha-nau mo Ake Ake Tonu. Wellington: National Advisory Committee
on Health and Disability. Cited in http://www.health.govt.nz/publication/report-new-zealand-cost-illness-studies-long-term-conditions
5
http://www.health.govt.nz/our-work/primary-health-care/better-sooner-more-convenient-primary-health-care
6
http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2
7
http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-services-and-projects/care-plus
8
http://www.health.govt.nz/our-work/diseases-and-conditions/diabetes/get-checked-programme

L Long-term Conditions
A disease-centered model focusing on cure does not Multidisciplinary care is particularly important in long-
adequately meet the needs of people with chronic term condition management. Care Plus7 and Diabetes Get
illness, particularly for psychological and long-term care Checked8 funding have both facilitated developing the
management. General practice care models have long nursing role in long-term conditions management.
been shifting from a disease-centered model to a model
of care that emphasises the individual managing and
living with chronic disease, illness and disability. Chronic
disease management aims to reduce the progression of
symptoms and further complications. The Wagner Model6
is an internationally recognised, evidence-based chronic
care model consisting of the basic elements for improving
care in health systems at the community, organisation,
practice and patient levels.
Communication
• create and negotiate management plans for patients • communicate results or prognosis – good, bad or
with a range of long-term conditions, encouraging them uncertain news – while recognising the health literacy
to be part of the decision-making and planning needs of the patient and their family/wha-nau
• manage the communication between primary care, • deal with delayed or incorrect diagnosis
secondary care and the patient, family/wha-nau and
carers
• explain the risks and benefits of preventive measures • explain and help with advanced care planning
and aid in implementing them
• employ culturally safe communication skills • consider and apply the communication skills required
when managing transitions in chronic conditions, for
example adolescence to adulthood, mobility to
immobility or starting dialysis
• discuss and promote screening of certain long-term • apply a supportive and empathetic approach to patients
conditions when appropriate, such as cardiovascular and their family/wha-nau and carers as part of
risk assessment screening maintaining a long-term relationship when managing
chronic illness and disability.

Long-term Conditions L
Clinical Expertise
• identify, assess and manage risk factors for common • be familiar with and where appropriate apply
long-term conditions Te Whare Tapa Wha and its role with the patient and
their wha-nau
• consider different aspects of managing long-term • recognise the aspects of disability that impact on
conditions with different age groups everyday life
• promote and enable self-management and patient • recognise the complexities of polypharmacy and aim
responsibility to minimise the use of medications, as appropriate
• apply knowledge and use of screening programmes and • recognise, understand and manage key clinical
early detection tools presentations.
• recognise mental health aspects of long-term

conditions and provide appropriate support
Professionalism
• recognise and enable patient autonomy • develop skills in maintaining self-care while managing
long-term and often difficult conditions
• promote self-management strategies to the patient, • engage in policy decisions to improve inter-professional
such as the Flinders model communication and funding initiatives and allocations.
• advocate for the patient as they negotiate the health

system


L Long-term Conditions
Scholarship
• undertake continuing medical education in common areas • promote and facilitate education of the practice team
to maintain knowledge of long-term conditions in managing long-term conditions
• audit practice management of both long-term conditions • undertake post-graduate diplomas or certificates to
and selected screening programmes increase knowledge of long-term condition management.
• be aware of the impact of geography and health service • appraise and discuss alternative therapies, including
policies on patient care traditional therapies
• familiarise themselves with key local supports at hospital • investigate local community support through allied health
and, in particular, non-governmental services, such as professionals.
Diabetes New Zealand
Management
• develop interdisciplinary care plans with person-centred • familiarise themselves with key policies affecting their
goals practice and the patient, for example using Care Plus
funding for patient or practice services
• be aware of practice policies on follow-up visits and • investigate practice activities to work towards a reduction
charges in long-term conditions and health inequalities.
• access and work with the multidisciplinary team and

community services for patients with long-term conditions
and disabilities

Ma-ori Health M
Ma-ori Health
The Treaty of Waitangi is New Zealand’s
founding document and forms part of
the country’s constitutional fabric. The
College recognises the status of the Treaty
and accepts its principles of partnership,
participation and active protection.
Features of the Treaty of high relevance to general practice There were 565,329 people who identified as belonging to
are providing protection for Ma-ori wellbeing, including the Ma-ori ethnic group in the 2006 Census, representing
a concern for achieving equity in health outcomes, and 15 percent of the total New Zealand population. Life
enabling the active participation of Ma-ori patients through expectancy at birth was 70.4 years for Ma-ori males and
clinical practice that transfers knowledge and skills to 75.1 years for Ma-ori females, while life expectancy at birth
patients and wha-nau to facilitate self-management. for non-Ma-ori males was 79.0 years and for non-Ma-ori
females 83.0 years. Overall, Ma-ori life expectancy at birth
Consistent with a Treaty-driven approach, Ma-ori health was at least eight years less than that for non-Ma-ori for
is integrated throughout the general practice curriculum. both genders. Ma-ori life expectancy rapidly increased
This indicates the commitment of the College to improving up until the late 1970s or early 1980s, after which Ma-ori
Ma-ori access to quality primary health care delivered by life expectancy was (mostly) static while non-Ma-ori life
culturally competent general practitioners and to achieving expectancy continued to increase. Since the late 1990s,
health equity for Ma-ori. Cultural competence requires an Ma-ori life expectancy has been increasing at about the
understanding of one’s own cultural background and how same rate as non-Ma-ori, or even slightly faster.1
this affects the doctor–patient relationship.
1
http://www.maorihealth.govt.nz/moh.nsf/indexma/life-expectancy
2
http://www.maorihealth.govt.nz/moh.nsf/indexma/avoidable-mortality-and-hospitalisation
3
Avoidable mortality includes deaths occurring to those less than 75 years old that could potentially have been avoided through population-based interventions or
through preventive and curative interventions at an individual level.
4
Amenable mortality is a subset of avoidable mortality and is restricted to deaths from conditions that are amenable to health care.
5
Avoidable hospitalisations are hospitalisations of people less than 75 years old that fall into three sub-categories:
- Preventable hospitalisations: hospitalisations resulting from diseases preventable through population-based health promotion strategies
- Ambulatory-sensitive hospitalisations: hospitalisations resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary
health care setting
- Injury-preventable hospitalisations: hospitalisations avoidable through injury prevention.
6
Ministry of Health website.
7
Ministry of Health. 2001. Priorities for Ma-ori and Pacific Health: Evidence from Epidemiology. Public Health Intelligence Occasional Bulletin No 3.

M Ma-ori Health
Ministry of Health information from Tatau Kahukura: Ma-ori The main focus to improve Ma-ori health is to support
Health Chart Book 20102 shows avoidable mortality3 rates general practitioners to develop the knowledge and skills
were over two and a half times higher for Ma-ori than for that will enable them to:
non-Ma-ori. Amenable mortality4 rates were more than two
times higher for Ma-ori than for non-Ma-ori. Ma-ori avoidable • understand the determinants of ethnic inequalities in
hospitalisations5 and ambulatory-sensitive hospitalisation health for Ma-ori
rates were over one and a half times higher than those for
• respond positively to Ma-ori patients and their wha-nau
non-Ma-ori.
and communicate effectively with them to achieve the
best results for them
Ma-ori have higher rates across many health conditions and
chronic diseases, including cancer, diabetes, cardiovascular • transfer knowledge and skills to Ma-ori patients and their
disease and asthma.6 In 2001 the Ministry of Health wha-nau to enable self-management
calculated the burden of disease for Ma-ori through disability
adjusted life years (DALY) as 75 percent greater than the • take a wha-nau ora-oriented approach to general practice
age-standardised DALY for European/other. Cardiovascular care for Ma-ori.
disease accounted for the highest male and female rates of
DALY loss due to any single disease group among Ma-ori. All general practitioners, Ma-ori and non-Ma-ori alike, have a
Cancers accounted for the second highest male and female vital role to play in improving health outcomes for Ma-ori.
rates of DALY loss among Ma-ori.7
Communication
• pronounce correctly Ma-ori personal and place names, • maintain appropriate, effective and supportive
and understand why this is important relationships with wha-nau, hapu-, iwi and other Ma-ori
community stakeholders
• respond positively to Ma-ori patients and their wha-nau, • communicate effectively with Ma-ori practice team
and communicate effectively with them to achieve the members, Ma-ori health care providers and Ma-ori
best results for patients and wha-nau community stakeholders.
• discuss with Ma-ori patients and wha-nau their preferences

for care and communication

Ma-ori Health M
Clinical Expertise
• discuss the implications of the Treaty of Waitangi for • understand the role of access to quality health care as
clinical practice a determinant of ethnic inequalities in health for Ma-ori
• understand the importance of wha-nau, hapu-, iwi, and the • identify barriers to Ma-ori access to health care at the
role of Ma-ori social structures in supporting Ma-ori health individual, organisational and structural levels and how
they may be overcome
• understand the potential of wha-nau as a network of • understand cultural characteristics that impact on clinical
support and reinforcement of positive health practices presentation and management to be able to work
in the daily life of patients effectively with Ma-ori
• understand the meaning of wha-nau ora and its • identify and contribute to initiatives designed to address
implications for clinical practice, and provide wha-nau inequalities in health for Ma-ori and improve Ma-ori health
ora-oriented general practice care
• understand and use documented Ma-ori models of health • understand how to take a population health approach
such as Te Whare Tapa Wha to primary care delivery and monitor inequities between
different practice populations
• describe and understand the key health issues affecting • advocate for collecting and using quality ethnicity data
Ma-ori and their implications for clinical practice to inform practice
• understand the historical, social, economic and political • discuss the range of Ma-ori health services available
determinants of Ma-ori health and their implications for and when referral is appropriate.
clinical practice

M Ma-ori Health
Professionalism
• understand and demonstrate cultural competence in • actively participate and, in some instances, take a
all aspects of clinical practice with Ma-ori patients and leadership role in inter-sectoral activities that contribute
wha-nau to wha-nau ora
• discuss strategies for consulting with Ma-ori • acknowledge and support Ma-ori doctors stepping into
leadership roles in Ma-ori health
• understand the role of kauma-tua and kuia in Ma-ori social • take on community and professional roles that contribute
structures and demonstrate respect for their status and to addressing ethnic inequalities in health for Ma-ori.
cultural expertise
• understand the GP’s role in death and dying and how

this applies within a Ma-ori cultural context
Scholarship
• understand the value of Ma-ori health research and other • use practice ethnicity data to identify and, where
research that contributes to addressing inequalities in appropriate, address potential inequalities between Ma-ori
health and contribute as appropriate and non-Ma-ori
• develop high-level competencies, such as Ma-ori language • develop interventions to address inequalities between
fluency, that facilitate culturally responsive practice that Ma-ori and non-Ma-ori patients and conduct reviews to
contributes to achieving health equity for Ma-ori monitor progress.

Ma-ori Health M
• understand the state of Ma-ori health and the extent • be aware of rongoa- and traditional Ma-ori healing and
of ethnic inequalities in health for Ma-ori both nationally local providers
and locally
• engage with Ma-ori providers and/or local resource people, • access and use the resources available to Ma-ori and
including Wha-nau Ora providers their wha-nau that will support their needs and improved
health outcomes
• understand who are the local hapu- and iwi, and their role • work with Ma-ori members of the practice team, Ma-ori
and activities in Ma-ori health health providers and Ma-ori community stakeholders to
support providing care to Ma-ori patients and their wha-nau.
Management
• ensure all staff in their practice are culturally competent • ensure all staff are trained to collect ethnicity data correctly,
or are supported to develop these skills and that this data is managed and used to inform practice
• develop processes to review how practice staff • lead quality initiatives in the practice that are aimed at
demonstrate cultural competencies health equity for Ma-ori.


M Curriculum
Men’s Health
for General Practice
Men’s Health
I have a few uncles who were farmers.
One or two of them popped off with bowel
cancer ‘cos their idea of when it was time
to go to the doctor was by the time you
were bleeding from the rear orifice and
in considerable pain, ‘cos they were just
brought up that you don’t groan, a bit of
aches and pains, a bit of blood—so what.1
Life expectancy for New Zealand men is currently 79 years, However, in a paper published in the Journal of Primary
4 years less than women. This gender disparity is closing, Health Care in 2009, McKinlay et al1 report that men’s
but slowly. Like most other aspects of health in New health beliefs included ‘balance in life’, ‘effective
Zealand, lower socioeconomic status and Ma-ori or Pacific relationships’ and ‘strong sense of self’. Men interviewed
ethnicity further reduces men’s life expectancy by up to felt that they would not go to a general practitioner without
a decade.2 Men are more likely to have elevated lipids, a reason, and did not feel that general practitioners offered
ischaemic heart disease and diabetes.3 Men are more anything for them unless they were sick or injured.
likely than women to commit suicide, particularly young
men, whose rate is three times higher than their female Men also may find it hard to make time to go to the doctor,
counterparts.4 Despite these health issues, men are less resent waiting and paying, and may also dislike or fear
likely than women to seek health care. physical contact and examination.
Why don’t men go to the doctor? When they do, they delay However, in the same issue of the Journal of Primary Health
it as long as possible, don’t always report the extent of Care, Barwell reports good uptake and value from invitation
their health concerns and often do not receive appropriate for a ‘Well Man Check’, with ‘23 of the 30 supposedly well
preventive care or opportunistic screening.1 men cases reviewed had one or more risks to their health that
required some formal treatment or follow-up to be initiated’.6
Contrary to some popular perceptions, men have quite a
complex relationship with their health. In one respect, there So, men can be considered a ‘hard to reach’ population
is the stoicism or fatalism reflected in the quote above, a and a proactive approach to screening and health
sense of ‘immortality or immunity from accident or disease’,5 promotion can pay dividends.
particularly seen in young men, and also an attitude that
health professionals are there to provide a ‘quick fix’ when
things go wrong.
1
McKinlay E, Kljakovic M, McBain L. 2009. New Zealand men’s health care: are we meeting the needs of men in general practice? New Zealand Journal of Primary
Care 1(4):302–310.
2
Ministry of Social Development. Life expectancy. In The Social Report. http://socialreport.msd.govt.nz/health/life-expectancy.html
3
New Zealand Health Information Service, Cause of death data citied In http://www.stats.govt.nz/browse_for_stats/population/births/new-zealand-life-tables-2005-07/
chapter-2-national-trends-in-longevity-and-mortality.aspx
4
Ministry of Health. 2010. Suicide Facts: Deaths and intentional self-harm hospitalisations 2008. Wellington: Ministry of Health.
5
Tudiver F, Talbot Y. 1999. Why don’t men seek help? Family physicians’ perspectives on help-seeking behaviour in men. J Fam Pract. 48(1):47–52
6
Barwell P. 2009. Do invitations to attend Well Man Checks result in increased male health screening in primary health care? New Zealand Journal of Primary Care
1:(4);311-314.

Men’s Health M
Communication
• establish an empathetic relationship in which a male • discuss and assess, in an open and professional manner,
patient can disclose symptoms he might consider sexual dysfunction in men
embarrassing or shameful
• establish rapport and communicate the need to address • understand the gender-specific patterns of presentation
lifestyle and metabolic factors increasing cardiovascular of depression in men
risk to men from all socioeconomic, educational and
ethnic backgrounds
• discuss safe sex, alcohol and drug use, risk-taking • include screening questions for alcohol use in
behaviour, emotional concerns and other issues using consultations with men
appropriate language in a non-judgmental manner,
especially with younger men
• discuss the pros and cons of prostate cancer screening, • take a comprehensive occupational history in assessment
allowing the patient to make an informed choice of men’s health.
Clinical Expertise
• detect and address cardiovascular risk factors in men, • elicit, assess and manage depression in men, including
including calculation of their five-year risk and risk assessment of underlying stressors and negative social
trajectory factors, and risk of self-harm
• reach an understanding of the arguments for and against • explain the precipitating factors of sexual dysfunction and
screening for prostate cancer, and formulate a rational provide up-to-date information about treatment options.
approach that they can apply in practice
• use appropriate and effective approaches to assessing

and helping reduce or cease smoking and harmful alcohol
use in men
Professionalism
• act as an advocate for male patients who need time • recognise the importance of providing reports in a timely
off work but find this difficult to ask for and comprehensive manner for third parties, such as ACC.

M Curriculum
Men’s Health
Scholarship
• consider and research issues relevant to men’s health, • apply reflective skills and identify areas of personal learning
and initiatives that might allow men to benefit from more
illness prevention and early diagnosis and management
• undertake a practice audit related to men’s health issues • show a willingness to teach and support the practice team
and selected screening programmes in men’s health.
• identify increased risks to men’s health through lifestyle • Have a knowledge of and refer appropriately to local
or occupation, particularly represented in their practice providers who specialize in aspects of men’s health
demographic
• Ensure adequate screening programmes are in place for

the practice population
Management
• consider how the primary care team could improve uptake • contribute to health education for men.
of screening and preventive health initiatives for men, and
how they might encourage and lead this

• Rural - Page 138

Mental Health M
Mental Health
In 2003 the Wellington School of Medicine
MaGPie group reported that 29 percent
of patients attending general practices
in New Zealand received some form of
psychological treatment.1 The World Health
Organization predicts that by 2020 major
depression will be one of the major causes
of disability in the developed world, second
only to cardiovascular disease.2
Te Rau Hinengaro, the New Zealand Mental Health Survey, General practice consulting skills contain many of the
found that 46.6 percent of the population is predicted to elements needed to diagnose and assess mental illness,
meet the criteria for a mental health disorder some time in and the ongoing relationship with the patient is the ideal
their lives with 20.7 percent having a disorder in the past context for treatment and ongoing management.
12 months.3
If we believe that in general practice we should take a whole-
Until recently there was little reliable data on the prevalence person, person-centred approach to health care, then mental
of mental illness in Ma-ori, but Te Rau Hinengaro4 found that health, in its most general sense, is part of nearly every
Ma-ori have a 12-month prevalence of mental disorder of interaction between doctor and patient. We must consider
29.5 percent, compared with 19.3 percent in the general it especially when caring for people with chronic conditions
New Zealand population. This indicates that, as in so many that change their lives, and when we meet patients who
other areas of health, there is a disparity in mental health for challenge our skills of diagnosis and communication.
Ma-ori, which we must address. The same is true, though
less marked, for Pacific people in New Zealand. Primary care is the first point of contact for most patients
with mental illness, and so general practitioners and their
Mental illness is a very significant part of the health care of teams, especially in rural practice, must be prepared to
New Zealanders and the majority can be diagnosed and effectively manage acute mental health crises in a manner
managed appropriately in primary care. that protects patient and staff safety.
1
MaGPie Research Group. 2003. The nature and prevalence of psychological problems in New Zealand primary healthcare: a report on mental health and general
practice investigation (MaGPie). New Zealand Medical Journal 116:1171–1185.
2
Murray CJ, Lopez AD. 1997. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 349:1498–504.
3
Oakley Browne MA, Wells JE, Scott KM (eds). 2006. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health.
4
2006. Ethnic comparisons of the 12-month prevalence of mental disorders and treatment contact in Te Rau Hinengaro: The New Zealand Mental Health Survey.
Australian and New Zealand Journal of Psychiatry 40 (10):905-913.

M Curriculum
Mental Health
Communication
• develop rapport and trust in the consultation to facilitate • discuss the different perceptions and models of mental
disclosure of symptoms of mental illness health in different ethnic groups, which may alter their
approach to communication and management
• introduce into the consultation and explore with the • consider a more holistic and wha-nau-based approach
patient the possibility of mental illness, in a compassionate when caring for Ma-ori patients
manner
• understand how the negative attitudes and perceptions • engage with the family/wha-nau when managing a
existing in society toward mental illness may affect patient’s mental health problems, with due consideration
presentations to sometimes conflicting issues of patient and family
safety, and patient confidentiality
• understand some of the underlying causes of ‘difficult’ • ensure patients with mental illness in their practice are
consultations and strategies to manage and improve these treated with respect and inclusiveness
• recognise the early warning signs in the acutely disturbed • use basic counselling skills competently in the consultation.
patient, and knowledge of principles of de-escalation
Clinical Expertise
• recognise and help alleviate the impact of mental illness • demonstrate safe and competent prescribing for
on the patient’s life mental illness.
• help patients develop coping behaviours to facilitate

transition through normal and traumatic life events

Mental Health M
The following subtopics are essential but do not cover the entire scope of mental health conditions managed by the GP.
Depression
• recognise, diagnose and assess severity of depression • offer patients the opportunity to be referred for group
in primary care particularly with at-risk groups therapy when and where appropriate
• recognise atypical presentations of depression • reflect on the benefits and limitations of online therapy
and promote it when appropriate
• discuss and recommend non-pharmaceutical interventions • manage postpartum psychosis as a rare but very
dangerous condition
• prescribe commonly used antidepressants, understand • use situational and age-appropriate communication
their indications, benefits, risks and potential side effects and screening tools
and how to initiate, follow up, monitor and discontinue
their use
• discuss the various biopsychosocial factors that increase • describe the concerns around antidepressant use in
risk of depression in certain patient groups adolescents and alternative and more appropriate
treatment approaches, such as cognitive behavioural
therapy.
• elicit and diagnose post-natal depression and have

knowledge of safe and effective treatment modalities
Anxiety
• recognise, diagnose and assess the spectrum of • develop and maintain knowledge of indications, benefits,
anxiety disorders side effects and risks of commonly prescribed anxiolytics,
including SSRIs, TCAs and benzodiazepines.
• understand the benefits and limitations of non-

pharmaceutical treatments, including awareness of some
online therapy sites

M Curriculum
Mental Health
Psychosis and Bipolar Affective Disorder
• understand the spectrum of mood stability disorders, • understand the principles of de-escalation and appropriate
their diagnosis and assessment of severity oral sedation when dealing with a manic and/or psychotic
patient
• diagnose and offer initial management of an episode • competently apply requirements relating to the Mental
of hypomania or mania Health Act, the role of the duly authorised officer and local
community mental health team protocols for compulsory
assessment to appropriate clinical cases
• prescribe commonly used mood-stabilising • recognise and manage safety issues around assessment
medications, and understand potential side effects, of an acutely disturbed patient.
follow-up and monitoring
Other conditions
• show some knowledge of more commonly encountered • safely restrain and use emergency sedation and transport
personality problems for compulsory assessment, complying with the Mental
Health Act
• manage self-harm, including risk assessment, in particular • recognise somatisation (bodily stress syndrome) as a
when isolated from emergency department and acute common presentation in general practice
mental health services
• understand the interaction between mental illness • make an early consideration of bodily stress syndrome as
and substance misuse and how this may affect their a ‘positive’ diagnosis when presented with functional or
management plan and referral pathways ‘hard to explain’ symptoms
• sensitively assess early warning signs that a patient is • introduce the possibility of bodily stress syndrome to the
becoming distressed or agitated, and use strategies to patient in an acceptable and understandable manner
manage this
• use non-confrontational consultation skills to de-escalate • institute some potential management options for
and prevent an acute crisis and suitable oral medication somatisation, including psychological therapy and
choices for sedation medication.

Mental Health M
Professionalism
• reflect on issues around confidentiality, privacy and • recognise and deal sensitively with the interpersonal
the need to involve family/wha-nau in patient care within implications of continuity of care, such as transference and
and outside practice, particularly in rural or small counter-transference
communities
• promote safety issues for themselves, other staff and • reflect and discuss how they might approach concerns
their patient, including exits from the consulting room about the mental health of a colleague
and emergency alerts
• understand the concept of ‘emotional labour’ of the • describe the Mental Health Act and its implications.
consultation, how this relates to mental health
consultations and ongoing care, and potential for
emotional exhaustion and burn-out
• consider and engage in supervision or mentoring as a

part of self-care for general practitioners
Scholarship
• maintain current knowledge of best practice in care for • willingly teach and lead all members of the primary care
patients with mental illness team in mental health diagnosis and management
• understand and discuss how to audit aspects of their • use available resources, such as print or electronic
management of patients with mental illness, such as information, or organisations and support groups.
prescribing

M Curriculum
Mental Health
• work towards reducing barriers to Ma-ori and Pacific • describe local resources and pathways to obtain help
people seeking and receiving mental health care in primary and support for patients with mental health problems
care in the New Zealand
• reflect on the demographics and other factors in their • involve mental health initiatives to facilitate access to care
practice that affect prevalence of mental illness
• be aware of and sensitive to the socioeconomic impact of • build effective relationships and work as a team with
serious mental illness community mental health services and other providers,
such as Ma-ori health providers.
Management
• recognise the importance of building and leading • compile a shared management plan for particular patients
a team approach to mental health in their practice who may use several mental health services
• reflect how they might manage financial issues of • discuss strategies to manage the potential increase in
extended consultations and time management relating mental health conditions in the practice population.
to patients with mental health problems


Musculoskeletal M
Musculoskeletal
Musculoskeletal symptoms are common
presentations in general practice with 8.9
percent of consultations attributed to this
patient group.1 They affect all age groups,
and range from acute to chronic, simple
to complex. They may be injury-related or
linked with a wide range of other conditions
and factors, including normal ageing.
Given the frequency of musculoskeletal presentations, early Accidental injury is a frequent cause of musculoskeletal
diagnosis, education and negotiation of a management symptoms. Preventive strategies, maintaining function and
plan are important, and may delay disease progression early return to work or activity should be encouraged by
considerably. These are skills that a general practitioner is general practitioners, where appropriate, supported by early
well placed to provide. Accurate and timely diagnosis and diagnosis and relevant investigations. Ma-ori are under-
management of paediatric conditions is also important. represented in ACC claim figures, which suggests cultural
The impact of long-term or progressive symptoms on an barriers still need to be overcome.2 The possibility of non-
individual, their family/wha-nau and carers may be financial, accidental injury must always be borne in mind, along with
but may also lead to mental health issues and other a clear strategy for management.
sequelae of chronic pain and increasing disability.
It is not unusual for patients to have sought treatment
Musculoskeletal conditions may be associated with or advice from elsewhere before presenting to a general
significant costs for both individuals and employers, and practitioner with musculoskeletal symptoms – hospital
may be implicated in time off work, limited work capacity specialists, allied health professionals, complementary
and early retirement. For those who are not in employment, practitioners, sports coaches, the internet and so
the cost may be in terms of ability to perform daily on. Interdisciplinary teamwork is a key feature in
activities, mobility and maintenance of independent living. musculoskeletal medicine, and is essential in managing
both acute and long-term effects.
1
http://www.health.govt.nz/publication/family-doctors-methodology-and-description-activity-private-gps
2
Accident Compensation Corporation. 2008. Te turoro Maori me a mahi. Wellington.
3
http://cnx.org/content/m13589/latest/
M Curriculum
Musculoskeletal
Communication
• obtain a relevant history that includes mechanism of injury, • deal with conflict that may arise when expectations
if any, and occupational factors cannot be met
• assess the impact of the condition on the patient and their • identify opportunities for screening, such as alcohol
family/wha-nau, immediately and in the long term screening for patients who present with acute gout
or recurrent falls.
• explain the natural history of the condition and normalise

without being dismissive
Clinical Expertise
• perform a relevant, focused examination for • explain how and where to access further care as required,
musculoskeletal presentation such as plastering facilities and orthopaedic aids
• consider appropriate age-related differential diagnoses for • explore options with the patient for chronic
musculoskeletal conditions musculoskeletal pain management or disability, taking
into account the principles of Te Whare Tapa Wha- and/or
the biopsychosocial model3
• identify red and yellow flags when eliciting a history • discuss the implications of surgery and pre- and post-
of injury operative care with patients and family/wha-nau
• remain alert to the possibility of non-accidental injury • manage non-specific musculoskeletal pain syndromes,
such as fibromyalgia
• assess and categorise levels of disability relating to • recognise acute orthopaedic conditions and undertake
musculoskeletal conditions, or refer for assessment if appropriate action
needed
• identify risk factors, such as unsafe lifting practices, poor • practise safe and appropriate prescribing, avoiding drug
mobility, obesity, unsafe home or work environments, and interactions and polypharmacy where possible, and
initiate further assessment and management establish appropriate care plans
• negotiate management plans for acute and/or chronic • evaluate the initiation of narcotics or other drugs of
conditions that take into account the needs and beliefs dependency to treat long-term chronic pain and, if
of the patient, their family/wha-nau, carers and employer, required, minimise their use.
and agencies, such as ACC and Work and Income

Musculoskeletal M
Professionalism
• maintain an ethical approach to discussions about • evaluate the level of skills required for managing
alternative providers, products and services musculoskeletal conditions in their area and up-skill
appropriately
• reflect on their personal parameters for prioritising • develop a clear process for reporting and managing non-
access to investigation and treatment accidental injury for all age groups
• advocate for the patient in obtaining services to treat • comply with medico-legal requirements for documentation
musculoskeletal conditions of accidental and non-accidental injury.
Scholarship
• apply the correct definitions for terms, such as ‘injury’, • document the mechanism of injury and other aspects
‘fully unfit’, ‘occupational overuse’, ‘gradual process’ of history and examination.
and so on, and recognise their implications
• develop a network of other providers to whom they can • consult with other providers, such as pain management
refer, while being aware of any access issues, which may specialists, if considering the use of narcotic analgesia
include preventive assessments and programmes for chronic pain management.
• know what is available in their area for imaging and

investigation services

M Curriculum
Musculoskeletal
Management
• evaluate the wise use of resources in their own practice, • contribute to develop safe handling and movement
including ordering relevant and useful investigations practices in workplaces, including their own
• maintain current knowledge of ACC protocols and those • identify and manage issues associated with acute
of other workplace injury programmes medical care and elective procedures, such as joint
replacement surgery.

• Addictions - Page 34
• Health and Work - Page 80
• Neurology - Page 107
- Page 119
• Rheumatology - Page 135

Neurology N
Neurology
Neurological disorders are common. They
may be a single diagnosis or part of a
complex disease pattern. Many conditions
have no cure and so health care is based
on alleviating symptoms. Neurological
problems lead to significant disability even
if their origin is benign, such as migraine.
For many, the disabling effects result in lost
working days. The effects on families and
communities can be life-changing.
Parkinson’s, Alzheimer’s, multiple sclerosis, Huntington’s, Additionally, the incidence of stroke is rising and, while it is
and motor neurone diseases, stroke, migraine, epilepsy and currently the third leading cause of death after cancer and
traumatic brain injury are just a few of the wide spectrum of heart disease, it is predicted in time to become the primary
disorders that general practitioners consult on. cause of death and disability in New Zealand. Stroke is a
preventable disease, but it is estimated that over 7,000
By 2051, it is estimated almost a third of New Zealanders New Zealanders experience a stroke every year, and
will be aged 65 and over and 2.7 percent of the population at least three-quarters of these people will die or be
will have dementia, and new cases will comprise dependent on others for care a year later, which again has
0.8 percent of the population each year after. Dementia significant implications for the nation as a whole.2
cases are expected to increase unless a cause, effective
treatments or, ultimately, a cure can be found. This has Health inequities are apparent in stroke statistics, with
major implications for the New Zealand health care system, the average age of stroke onset for Ma-ori at 61 years,
as well as economic and social impacts.1 compared to 64 years for Pacific people and over 75 years
for Europeans,3 with some evidence suggesting that the
chance of being dependent at 12 months following a stroke
is three times higher for Ma-ori compared to Europeans.4
1
http://www.alzheimers.org.nz/assets/Reports/AnnualReports/Dementia_Economic_Impact_Report2008.pdf
2
http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj33/33-stroke-a-picture-of-health-disparities-
in-new-zealand-p178-191.html
3
Feigin V, K. Carter K et al. (2006) “Ethnic disparities incidence of stroke subtypes: Auckland Regional Community Study” Neurology: The Lancet, 5(1):130-139.
4
McNaughton H, Weatherall M et al. (2002) “The comparability of community outcomes for European and non-European survivors of stroke in New Zealand”
New Zealand Medical Journal, 115(1149):98-100.
5
http://www.brain-injury.org.nz/index.html

N Curriculum
Neurology for General Practice
Another significant neurological presentation is brain injury. A general practitioner needs to be vigilant when assessing
This can be anything from an internal trauma to a traumatic both acute and chronic neurological conditions, and be able
brain injury (TBI). The major causes of TBI are motor vehicle to manage them competently and recognise the long-term
crashes, followed by sports injuries, assaults and falls. The nature of some of these conditions.
highest-risk groups for sustaining TBI are children under
5 years of age, men aged 15-30 years, and the elderly.5
Significant accidents leading to neurological consequences
commonly happen on rural roads.
Communication
• take a comprehensive history of the neurological • communicate restrictions on activities that chronic
symptoms while establishing the relationship and neurological conditions might require, such as restrictions
maintaining a rapport on driving for patients with epilepsy.
• explain common neurological diagnoses and their

implications to their patients and family/wha-nau in
a manner understandable to the patient
Clinical Expertise
• identify red flags relating to neurological conditions • manage head injury, including acute assessment,
and refer accordingly, for example temporal arteritis transfer from a rural area as necessary, and post-
concussion issues
• diagnose common neurological disorders and treat • initiate palliative care when required for chronic
and prescribe appropriately or inoperable neurological conditions
• conduct a full neurological examination, taking into • investigate for risk of developing neurological conditions
consideration history and time constraints
• treat acute neurological emergencies, such as status • provide ongoing management for patients with paraplegia
epilepticus or tetraplegia while supporting independence as much as
possible and encourage a team approach
• understand and appropriately manage sequelae of • recognise the impact of chronic neurological conditions
chronic neurological conditions and the impact on on a patient’s relationships, occupations, social status
other health care, such as migraine with aura and oral and everyday function.
contraception

Neurology N
Professionalism
• discuss the inter-professional relationships they have • recognise the impact of neurological conditions on
developed to enable them to care for people with everyday living and be able to provide support and
common neurological disorders in their community advocacy for patients.
Scholarship
• discuss clinical knowledge of the pathology, • show how they might use the process of audit to ensure
epidemiology and clinical issues associated with the care of their patients with neurological diseases is
common neurological disorders optimum.
• acquire knowledge of rare conditions that may present

in their patient case loads
• explain how they work with support services in the • understand the impact of disabling neurological conditions
community to enhance the care of people with when living in rural and remote areas.
neurological conditions
• understand the differences in health care provision and

outcomes for Ma-ori patients with neurological conditions,
such as stroke

N Curriculum
Neurology for General Practice
Management
• educate their practice team and community about • develop policies in their practice that ensure patients with
neurological disease neurological diseases are getting the very best health care
• ensure there is a safe practice environment for patients • develop relationships with local services involved in
who have neurological conditions, such as for those acute treatment and transfer of patients with neurological
in wheelchairs conditions.

• Endocrinology - Page 59
• Eyes - Page 66
• Neurology - Page 107
- Page 119

Older People O
Older People
General practitioners are very often in a
privileged position of being able to practise
care of several generations of the same family.
Older patients need relatively high levels of
health care and disability support. Additionally,
the carers of older people also require support
from general practitioners to proactively
manage the real problems of increasing
dependency and loss of mental competence.
The OECD defines ‘ageing in place’ as ‘The ability to live in Older people are fairly evenly distributed across the
one’s own home and community safely, independently, and socioeconomic spectrum; however, older Ma-ori are
comfortably, regardless of age, income, or ability level.’ This skewed towards the high deprivation end of the scale.
policy is a focus for supporting our ageing population in New Rural-dwelling elderly people in New Zealand are at
Zealand.1 General practitioners who are well grounded in their risk of isolation from families, health and social agency
communities play a vital role in bringing this policy into effect. support. General practice is a safety net for these elderly
patients and needs to be sensitive to their needs and the
The number of New Zealanders over the age of 65 years characteristics of the local community.
is predicted to rise from 500,000 in 2005 to 1,330,000
by 2051. In 2005, 12 percent of the population was 65+ Older patients must have trust and confidence in their
years old and it is projected that by the late 2030s over 25 general practitioner to understand their clinical needs.
percent of the population will be of that age.2 This trust is built up over many years of longitudinal care
and support. To be effective, members of the primary care
Older people represent a diverse range of ethnicities. team general practitioners need to be able to collaborate
However, due to ethnic differences in migration, mortality with and, on occasion, lead and coordinate family/wha-nau,
and fertility, Ma-ori, Asian and Pacific populations will carers and the interdisciplinary team.
remain slightly younger than the background European
population. General practitioners require the skills to
communicate effectively and sensitively with older people
of different cultural groups and engage with family/wha-nau
in a collaborative way that respects the rights of the older
patient.
1
Davey J. 2006. ‘“Ageing in place”: the views of older homeowners on maintenance, renovation and adaptation’ Social Policy Journal of New Zealand 27, 128–141.
2
Bryant J. 2003. “The Ageing of the New Zealand Population, 1881–2051”, New Zealand Treasury Working Paper 03/27, http://www.treasury.govt.nz/
workingpapers/2003/twp03-27.pdf

O Older
Curriculum
People
Communication
• communicate with older people, taking into account • recognise and manage cultural and linguistic factors when
possible physical and cognitive disability, failing hearing communicating with older patients, especially those who
and sight do not speak English as their first language
• explore the patient’s beliefs, concerns and expectations, • provide clear patient care instructions to carers,
integrating the doctor’s agenda, finding common ground family/wha-nau and rest home staff
and negotiating shared plans for the future
• recognise the status of older people, in particular in ethnic • discuss with sensitivity issues and decisions about
groups, and demonstrate communication skill appropriate end-of-life care.
to this, such as with kauma-tua or kuia
Clinical Expertise
• discuss with patients and family/ wha-nau safety issues • diagnose and manage conditions commonly associated
related to physical changes with age, such as the ability with ageing
to drive
• help the patient’s functional needs and help them to • recognise the significant problem of polypharmacy and
maintain independence, as appropriate aim to minimise the use of medications
• understand the physical, psychological and social changes • recognise the interactions and complications of
that may occur with age, especially in relation to loss of a multisystem diseases and conditions and manage
partner, other bereavements, isolation and loneliness these appropriately
• recognise how an ageing person adapts to the ageing • incorporate preventive care activities into their practice.
process, and how the breakdown of these adaptions
leads to disability
• employ knowledge of all branches of medicine,

recognising where this may differ in older people, and that
the goals of diagnosis, management and prognosis, and
overall context, may differ

Older People O
Professionalism
• adopt an attitude of respect for the older patient’s dignity • recognise how age discrimination can affect managing
and autonomy older patients
• employ culturally safe and non-discriminatory attitudes • examine the ethics of how the capacity for informed
and practices consent can be impaired, and involve family/wha-nau
and carers in the power of attorney, as appropriate
• apply a balance between emotional distance and proximity • employ ethical principles of informed consent with
to the patient patients when formulating advanced care plans and
discussing end-of-life care issues
• recognise psychological influences of counter-transference • describe the potential difficulties of managing unwell
and conflicts of interest in relationships with older patients older people in rural or remote communities and the ways
and their families/wha-nau of maintaining their safety and care.
Scholarship
• adopt appropriate medical record systems to manage • incorporate evidence-based advances in knowledge
the range of health issues which impact on older people and practice into the care of older people
• practise up-to-date management of conditions in • identify their own gaps in knowledge and skills in relation
older people to older people’s care and demonstrate a commitment
to lifelong learning in practice.
• ensure knowledge of prescribing for older people is

current and up to date, in particular in the areas of
pharmacokinetics, pharmacodynamics, and polypharmacy

O Older
Curriculum
People
• maintain an up-to-date list of community resources • evaluate the inequalities in health care provision in relation
available for the care of older people to age, disability, ethnicity and rurality
• understand the role of other health care professionals • incorporate health promotion and disease prevention
and a willingness to practise collaboratively with them into older people’s care.
• distinguish the influence of ethnicity, poverty and local

epidemiology on the local community’s health
Management
• coordinate teamwork in primary care involving family/ • compare and reconcile the individual needs of older
wha-nau, carers, volunteers and allied health professionals people and the priorities of the community and health
service, balancing these with available resources
• contribute to staff training and education • compare the allocation of resources to older people living
in rural and urban communities and devise strategies to
maximise equity.

• Musculoskeletal - Page 103

Oncology O
Oncology
Cancer is one of the leading causes of death
in New Zealand, accounting for around
29 percent of deaths from all causes.1 This
increasing incidence is in part due to ageing
of the population. In particular, Ma-ori and
Pacific people are over-represented in cancer
statistics, and may present later in their illness
for a variety of reasons. This further increases
the gap in life expectancy for Ma-ori and
Pacific people compared to all others.
Cancer treatment in New Zealand is provided at most district The role of the general practitioner is to provide professional
health boards (DHBs) in New Zealand overseen by six regional skills, knowledge and support of the patient, family/wha-nau
cancer centre DHBs. This means that many patients may and carers from screening and prevention, through diagnosis,
have to travel significant distances to receive active treatment, treatment, ongoing surveillance and where appropriate,
making all those who live outside the main centres ‘remote’. palliative and bereavement care. Advocating for the patient
This may have a profound impact on all aspects of their and coordination of care are vital roles. Culturally safe practice,
wellbeing and that of their family/wha-nau and carers, and will in its broadest sense, is paramount.
add an extra, difficult dimension to treatment decisions.
It has been stated that an ‘average general practitioner’ will

have around four patients per year who are newly diagnosed
with a potentially fatal malignancy.2 This is a relatively
uncommon but important occurrence in general practice
and the support of an interdisciplinary team is essential. New
Zealand guidelines are available and are aimed at streamlining
investigation, referral and reducing ethnic disparities when
dealing with suspected cancer in primary care.3
1
Ministry of Health. 2010. Cancer: New Registrations and Deaths 2006. Wellington: Ministry of Health.
2
McAvoy BR. 2007. General practitioners and cancer control. Med J Aust 187:115-117.
3
New Zealand Guidelines Group. 2009. Suspected Cancer in Primary Care: Guidelines for investigation, referral and reducing ethnic disparities.
Ministry of Health, Wellington.

O Oncology
Communication
• employ culturally safe communication skills, recognising • deal with delayed or incorrect diagnosis and manage
the impact of their own culture on the consultation this appropriately
• discuss and promote screening and risk management • advocate for the patient as they negotiate the health
regularly in the practice and consultations system and enable access to available services that relate
to cancer treatment and management
• provide competent pre-test discussion and counselling • explain and help with advanced care planning,
acknowledging the potential emotional impact on
the patient and their family/wha-nau.
• communicate results or prognosis – good, bad or uncertain

news – while taking into consideration the health literacy
level of the patient and their family/wha-nau
Clinical Expertise
• identify, assess and manage risk factors, such as lifestyle, • manage malignancies that have guidelines for general
environmental, familial and dietary practitioner management, and refer and coordinate care
for others
• use their knowledge of screening programmes and early • recognise and manage common symptoms and side
detection tools, to identify barriers and possible solutions effects during or after treatment in conjunction with
the treating oncology team
• perform relevant screening tests • help clarify the benefits and risks of treatment options
to patients and their family/wha-nau – this may include the
option of no active treatment
• identify and investigate significant symptoms, including • know how and when to access more specialised
those of metastatic disease, and refer appropriately knowledge and advice
• identify common malignancies • recognise when the transition to palliative care occurs
• identify red flags during medical and radiation oncology • recognise the capabilities of the rural hospital and team
treatment delivery for cancer treatment, if appropriate.

Oncology O
Professionalism
• recognise the need for support of family/wha-nau, carers • appraise alternative or integrative therapies,
and colleagues and describe ways of enabling this including traditional therapies, in an ethical manner while
recognising the goals and needs of the patient
• apply the principles of Te Whare Tapa Wha and understand • define confidentiality and personal boundaries for
its implications for the patient, their family/wha-nau and each situation, and re-evaluate them as necessary
carers, especially in the context of cancer treatments
• understand the ethical issues that may surround screening • manage inter-professional relationships, including
and early detection of asymptomatic disease non-medical ones, such as tohunga
• recognise and enable patient autonomy • understand and empathise with a patient on their journey
through cancer (diagnosis, treatment and management)
and take steps to support and enable this.
Scholarship
• record screening and risk factors for cancer • appraise the risks, benefits and evidence for
complementary therapies
• reflect on personal knowledge, attitudes and experiences, • recognise the limitations of an evidence base, particularly
identifying areas to explore and develop in palliative care
• develop awareness and knowledge of current cancer • take part in ongoing education to up-skill in appropriate
treatment trials any patients may be involved in aspects of symptom management.
• be conversant with the National Screening Programmes • engage with other allied health providers in creating a team
and their implementation in practice approach to support patients and their family/wha-nau
• maintain professional relationships with the patient, their • develop and maintain knowledge of cancers that are
family/wha-nau, carers, other specialist and allied health particularly prevalent in New Zealand and the screening,
providers and community support groups, such as the treatments for and management of them.
Cancer Society

O Oncology
Management
• maintain up-to-date resources for patient information • ensure there is clear responsibility for care coordination,
and support ideally by the GP, remembering that the team may be
geographically dispersed.
• understand the impact of geography on patient care

• Genetics - Page 77
- Page 119
• most other curriculum statements

Paediatrics and Immunisations P
Paediatrics and Immunisations

General practitioners are closely involved
in the care of children from conception to
adulthood. Paediatric care specifically covers
children from birth through to their teens.
Caring for children as a general practitioner is
a journey of lifelong learning, and appropriate
medical intervention at this life stage could be
said to have more benefit to the community
in the long term than any other investment in
health care.1
‘A number of risk factors for many adult diseases such as There are a number of schemes in place to ensure the
diabetes, heart disease and some mental health conditions wellbeing of children, including Well Child/Tamariki Ora,
such as depression arise in childhood. Child health, and the B4 School Checks. These initiatives are designed
development and wellbeing also have broader effects on to provide intervention services to ensure children’s
educational achievement, violence, crime and unemployment.’2 development is monitored and any health issues are
identified early.
The New Zealand Health Survey in 2006/07 found that
one in five children aged 2 to 14 years were overweight Infectious disease is common in New Zealand. Immunisation
(20.9 percent) and one in twelve was obese (8.3 percent).3 coverage is important to protect the health of the individual
Obesity in children is associated with a wide range of and the wider community. When coverage of immunisation
medical conditions, such as asthma, endocrine conditions, is higher it reduces the spread of infectious diseases to those
musculoskeletal problems and psychological issues. General who have not been vaccinated.4
practitioners need to provide advice and support to family/
wha-nau about the risks to their children to ensure good
health outcomes.
1
Families Commission. Investing in the Early Years: Issues Paper 05. http://www.nzfamilies.org.nz/web/investing-early-years/index.html
2
Ministry of Health. Child Health. http://www.health.govt.nz/our-work/life-stages/child-health
3
Ministry of Health A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey
http://www.health.govt.nz/publication/portrait-health-key-results-2006-07-new-zealand-health-survey
4
Ministry of Health. Immunisation coverage. http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage

P Curriculum
Paediatrics for
andGeneral
Immunisations
Practice
Acute rheumatic fever is a significant issue facing New Ma-ori are a young population with a median age of 23 years,
Zealand children, particularly among Ma-ori and Pacific compared to 36 years for the total population. In 2006, 35
populations. It is also has geographical disparities and is percent of Ma-ori were under 5 years of age and 53 percent
linked to areas with high social depravation. Rates have not under the age of 25 years. The impact of paediatric care is a
decreased since the 1980s and remain among the highest in significant factor in altering health outcomes for Ma-ori.
the developed world. The Government has implemented a
prevention programme targeting seven high-risk rheumatic A 2009 study found the delivery of childhood immunisation
fever regions.5 is less effective for Ma-ori children, who have lower levels of
immunisation coverage. All-cause mortality rates for Ma-ori
New Zealand has one of the highest rates of child abuse children are significantly higher than those of non-Ma-ori
in the developed world.6 Abuse comes in many forms from children and for many conditions hospitalisation rates for
physical abuse to neglect for the child’s welfare and needs. Ma-ori children exceed those of non-Ma-ori children. The
The immediate effects are devastating for the child and report also suggested that primary care services to Ma-ori
the family/wha-nau and the physical and emotional harm children need to be improved to reduce the level of
will likely affect the behaviour of the child throughout their avoidable hospitalisations.9
adolescence and through to adulthood.
General practitioners are required to understand a wide
Child abuse has been linked to a number of negative range of issues involved in paediatric care and need to be
outcomes for victims throughout their adolescence, able to recognise and effectively manage situations that
including mental health issues, low self-esteem, sexual require intervention to ensure the wellbeing and positive
difficulties and interpersonal problems.7 Sexual abuse in development of the child.
childhood is an issue in New Zealand with approximately
30 percent of women reporting sexual abuse and 10 percent
of men. Child sexual abuse has been linked to higher
numbers of sexual partners, higher contract rates of sexually
transmitted infections and unhappy pregnancies and
abortions in those who have been abused.8
5
Jaine R, Baker M, Venugopal K. 2008. Epidemiology of acute rheumatic fever in New Zealand Wellington: Department of Public Health, University of Otago.
6
Every child counts. Child Abuse. http://www.everychildcounts.org.nz/resources/child-abuse/
7
Mulle PE, Martin JL, Anderson JC, Romans SE, Herbison GP. 1996. The long-term impact of physical, emotional and sexual abuse of children: A community study,
In Child Abuse and Neglect 20(1):7-21.
8
van Roode T, Dickson N, Herbison P, Paul C. 2009. Child sexual abuse and persistence of risky sexual behaviours and negative sexual outcomes over adulthood:
Findings from a birth cohort. Child Abuse & Neglect 33(3):161-172.
9
Smylie J, Adomako P (eds). 2009. Health of Indigenous Children: Health Assessment in Action Keenan Research Centre – Research Programs. Centre for Research
on Inner City Health.

Communication
• elicit a comprehensive history from the family/wha-nau, • encourage and support parenting skills and healthy
carers and children to ascertain the full extent of the environments for children
presentation
• communicate with children of all ages and their family/ • manage complex consultations where the entire family/
wha-nau wha-nau are present and/or more than one sibling is unwell.
• discuss the immunisations available on the national

schedule, recognising personal choice and discussing
this in a non-judgemental manner
Clinical Expertise
• diagnose the common illnesses of childhood and manage • recognise the signs of child abuse or neglect and refer
them appropriately appropriately
• recognise disability in childhood and refer appropriately • undertake an age-appropriate examination of a child
• respond to serious paediatric illness at an early stage • provide paediatric life support as required in their
particular working environment
• distinguish between normal and abnormal development • prescribe for children, recognising risks and harms
associated with some treatments.
• recognise common behavioural or mental health

conditions that present in childhood

P Curriculum
Paediatrics for
andGeneral
Immunisations
Practice
Professionalism
• respect the wishes of parents for immunisations while • recognise specific difficulties for children that may arise
still ensuring they have the relevant information to make when there are changes in the family structure and the
an informed choice impact this might have on the consultation process
• describe their practice policy for ensuring the rights • discuss legislation, policies and support systems available
of children for the protection and care of children.
• ensure the practice environment is safe for children
Scholarship
• describe how they use audit to ensure the care of their • write appropriate reports as required in relation to
children is best practice consultations with children
• keep comprehensive notes detailing history and • undertake ongoing learning in paediatric childhood
examination management and those present in the conditions.
consultation
• recognise the influence of the family/wha-nau on • establish relationships with allied health services involved
prevention, presentation and management of childhood with children
illness and injury
• identify community and other resources available to • describe the various government agencies available to
help infants and children and their family/wha-nau, and children and their family/wha-nau and carers.
access these effectively

Management
• manage an immunisation protocol within the context • recognise the health inequalities that relate to Ma-ori
of their practice team children and instigate measures to reduce these
• educate their practice team and colleagues about • discuss ‘cold chain’ protocols for safe storage of vaccines
common childhood illnesses and its management within the practice
• manage an outbreak of an infectious disease within • discuss protocols for dealing with urgent childhood
the children of the population they care for consultations in a busy practice.

- Page 38
• Genetics - Page 77

P Curriculum
Population and
for General
Public Health
Practice
Population and Public Health

A population health approach takes into
account all factors that determine a person’s
health and wellbeing, and it plans how these
factors can be addressed. These factors are
called the determinants of health and include
the environmental factors that affect the health
outcomes of a population.1
The social determinants of health are the conditions in which The report also found a substantial health burden due to obesity
people are born, grow, live, work and age, including the health partly because of decreasing levels of physical activity, high
system. These circumstances are shaped by the distribution of blood pressure and lack of fruit and vegetables.
money, power and resources at global, national and local levels
and are often responsible for health inequalities in New Zealand. Public health also involves managing the spread of disease
through a population. Managing the spread of communicable
Primary health care is recognised as being an important diseases not only involves immunisation and screening
intervention point for improving the health of a population. programmes, but also management of communicable disease
In particular, emphasis on promoting health, community that may have an impact on both local and wider populations.
participation, and accurate data collection can help with the
population health approach. An investment in activities that Child health, in particular that of Ma-ori and Pacific children,
influence key determinants of health identified at government requires well-resourced intervention, especially to address
level, a commitment to reducing existing inequalities and the negative impact of poor socioeconomic conditions
focusing on workforce development will also contribute to that affect their health, education and lifestyle. Health and
improving the health of the population.2 social inequalities can be reduced by initiating cost-effective
approaches in areas such as maternal health, child health
Many conditions that general practitioners see have a lifestyle services, early childhood programmes, education, housing
choice or other social determinant underpinning them. Nutrition and social development.
is a serious health issue that is having a significant effect on the
health of the New Zealand population. A report released by the GPs have an important role in transforming a variety of
Ministry of Health and The University of Auckland3 estimates lifestyle activities that impact negatively on people’s health.
that nutrition plays a role in about 11,000 deaths a year in Collaboration with other professionals in government, health,
New Zealand (two in every five deaths), of which approximately welfare and education is required to address the many issues
8000–9000 reflect diet, and 2000–3000 reflect physical facing the New Zealand population at large.
inactivity. With over 4500 premature deaths in 1997 attributed
to high cholesterol, the report highlights the health impact of
prolonged high intake of saturated fat.
1
World Health Organization. Social Determinants of Health. Geneva: World Health Organization. Available at: http://www.who.int/social_determinants/en/
2
Neuwelt P, Matheson D, Arroll B, Dowell A, Winnard D, Crampton P , Sheridan NF, Cumming J. 2009. Putting population health into practice through primary health care.
NZ Med J. 122(1290):98-104.
3
Ministry of Health and The University of Auckland. 2003. Nutrition and the Burden of Disease: New Zealand 1997-2011. Wellington: Ministry of Health.

Population and Public Health P
Communication
• communicate the benefits and risks of population health • use the communication skills required when informing
activities, such as immunisation programmes, to patients, patients of serious conditions that have both personal
family/wha-nau and communities in a non-judgmental way and public health implications, such as hepatitis and HIV
• discuss all aspects of infectious diseases with patients, • use brief intervention for conditions that have an impact
and where appropriate their family/wha-nau, and the on population health, such as smoking, diet and exercise
implications of these for the wider population
• describe the various diet-related conditions that contribute • discuss the specific requirements of confidentiality and
to the burden of disease in New Zealand and ways of the ethical issues behind notifying other authorities and
discussing these with patients and their family/wha-nau disclosure of patient information and how to communicate
and carers these, such as through contact tracing.
Clinical Expertise
• discuss the childhood immunisation schedule and the • describe the implications of long-term conditions on
conditions it protects against the population and individuals, and ways to reduce
adverse outcomes
• describe the various notifiable diseases and the • record lifestyle factors that impact on the health of
assessment, treatment and long-term management individual patients and interventions undertaken to
of them reduce the risk of developing chronic conditions
• discuss the health implications of immigration to • recognise the benefit of proactive, individually targeted
New Zealand and how to assess them lifestyle and nutritional interventions that can lead to
protection from future serious disease.

P Curriculum
Population and
for General
Public Health
Practice
Professionalism
• advocate in relation to determinants of health, providing • describe the principles of ‘cold chain’ management and
equitable access to interventions that are available the protocols within the practice
• be aware of the privacy issues that relate to contact tracing • describe the infection control activities within their own
practice, such as sterilisation and hand-washing
• describe the protocols within the practice for containment • undertake whole-practice training in managing significant
of infectious diseases and providing protection for the events, cold chain management and pandemic or
practice team and other patients emergency planning.
• be aware of the process for reporting infectious and

notifiable diseases and access resources to aid the
process
Scholarship
• write appropriate referrals to services involved with • undertake regular audit of screening programmes within
public health the practice and describe ways to improve outcomes
from screening.
• appraise evidence on public and population health issues

and apply this to their practice, recognising the central
role general practice has in improving outcomes
• describe the Ministry of Health targets for population • describe the various public health services available in
health outcomes the area
• explore the role and activities of the local PHO in • discuss the role of the medical officer of health
improving population health
• be aware of the activities undertaken by and targets for the • access immigration services in their local area.
National Screening Unit and the involvement of primary
care in meeting these targets

Population and Public Health P
Management
• discuss priorities identified through the PHO performance • undertake pandemic planning within the practice and
indicators process community
• review regularly practice performance against the PHO • demonstrate the skills and knowledge of general practice
performance indicators and discuss ways to improve this involvement in pandemic planning and protocols of the
within the team individual practice
• implement the protocols and standing orders for • describe the role of primary care in managing population
vaccination for, for example, seasonal flu health and the individual role of the general practitioner,
general practice team and wider primary care community
• discuss the changing nature of work relationships due • prepare emergency management systems in the case
to the influence of health priorities, changes in health of an unseen event or natural disaster.
care, structures and systems
• consider the use of resources and their equitable

distribution in the practice population


R Renal
Curriculum
and Urology
Renal and Urology

Renal disease is exponentially expanding in
New Zealand and is becoming something
primary care will be required to manage more
of as the health system tries to cope with the
burden of more and more dialysis patients.
Ma-ori and Pacific people in particular are
affected by this and need preventive and
early intervention.
Issues relating to the urinary tract extend from the kidneys to Other conditions such as renal colic, haematuria and prostatic
the end of the urethra. There is considerable overlap with the issues are common presentations in general practice and the
topics of women’s and men’s health, as well as sexual health effective management of these is essential.
and even diabetes, in particular with renal disease.
Prevention of chronic renal disease is one of the important
The number of people requiring treatment for renal disease in roles of primary care. Renal failure deaths were 3.5 times
New Zealand is expected to rise at a rate higher than would more common among Ma-ori than non-Ma-ori in 2000-2005.2
be attributable to the natural increase in the population. It is Knowledge of the preventable causes of renal disease is
estimated that almost half of the total projected growth would essential to improving health outcomes in this area.
be attributable to the increasing rates of type II diabetes
associated with increasing rates of obesity.1

• Endocrinology - Page 59
1
National Renal Advisory Board. 2006. New Zealand’s Renal Services Towards a national strategic plan (scoping paper), www.health.govt.nz/system/files/
documents/.../nz-renal-services.pdf
2
Harwood M, Tipene-Leach D. 2007. Diabetes. In Robson B, Harris R. (eds), Hauora: Ma-ori Standards of Health IV. A study of the years 2000-2005 160-167.
- pu- Rangahau Hauora a Eru Po
Wellington: Te Ro - mare.

Renal and Urology R
Communication
• outline the rules and limits of confidentiality, including • provide accurate, honest explanation and education
using translators when communicating with patients appropriate to the age and stage of the patient
with renal conditions
• use appropriate language that does not discriminate • provide evidence-based pre-test counselling for prostate
against age, gender, disability or ethnicity screening where appropriate.
• take an appropriate history for risk factors of chronic

kidney disease
Clinical Expertise
• perform a focused examination, being sensitive to the • prescribe medication for renal conditions and discuss
privacy of the patient and any cultural requirements the impact of various medications on renal function
• recognise that using a chaperone is a safe practice for • have core knowledge of appropriate management and
doctor and patient referral for the common and key renal and urological
conditions seen in primary care
• investigate renal conditions through ordering appropriate • have an understanding of palliative care issues with
tests as well as demonstrate skill in taking samples end-stage renal disease.
when required
Professionalism
• establish clear professional boundaries for confidentiality • be aware of patients’ attitudes, beliefs and reasons for
within the practice team, particularly in rural communities choosing not to have dialysis or recommended treatments.
• be sensitive towards patients who are in denial, or seem

unwilling to engage in behaviour change recommended
by the medical team

R Renal
Curriculum
and Urology
Scholarship
• use opportunities to attend professional development • act as advocate for the patient in writing referrals,
and update personal and team knowledge particularly when there is pressure or limited availability
of services.
• audit practice in relation to renal disease
• identify groups vulnerable to renal disease within the • access services for home dialysis and, in rural areas in
practice population particular, discuss travel and other barriers to dialysis
• identify and use other providers of patient information • implement screening programmes as appropriate locally
and support for renal disease and incontinence or nationally for urological conditions, such as prostate
conditions
• describe resources provided by hospitals and secondary • consider the impact of renal disease on occupation,
care in the local area needing time for dialysis.
Management
• discuss chronic disease management funding and how • provide leadership in the practice team in reducing
this is used in the practice inequalities in care for patients with renal conditions
• describe local guidelines for managing renal disease and • provide resources to patients to help inform them about
other conditions, such as general practitioner access to renal and urological conditions.
CTU for renal stones

Respiratory Medicine R
Respiratory Medicine
In New Zealand, respiratory disease is a
significant cause of morbidity and death.
In some parts of New Zealand, 95 percent
of avoidable respiratory deaths are caused
by chronic obstructive pulmonary disease
(COPD) and between 2 and 3 percent are
due to asthma.1
COPD affects approximately 200,000 New Zealanders, Asthma is the most common chronic disease among children
representing 15 percent of adults over 45 years.2 It has a with half of all sufferers developing the condition before 10 years
significant impact on people’s quality of life and longevity, and of age. New Zealand has the second highest rate of asthma in
Ma-ori, Pacific people and people of low socioeconomic status the world with one in six adults and one in six children suffering
have higher levels of chronic respiratory disease than the rest of from the condition.
the population.3
Asthma rates are similar for Ma-ori and non-Ma-ori children
With an aging New Zealand population, the burden of disease with the rate for Pacific children slightly lower. However, Ma-ori
is likely to increase. COPD is the fourth most common cause and Pacific adults tend to have higher rates, and more severe
of death after cancer, heart disease and stroke in New Zealand. asthma, than other ethnic groups.4 General practice has a
Smoking is an environmental factor that contributes to the rate major role in managing outpatient asthma along best practice
of COPD and is the major contributor to the developing COPD guidelines to avoid preventable hospitalisation and death.
and lung cancer.3
Obstructive sleep apnoea, another contributor to preventable
Upper and lower respiratory tract infections, including deaths, has high community prevalence and brings with it
community-acquired pneumonia (CAP), are illnesses that can an economic burden. Initial assessment and management
contribute to significant morbidity and mortality, and present happen in primary care and all general practitioners need a
initially in general practice. CAP has a significant economic good working knowledge of causes of excessive sleepiness. It
impact on medical costs and productivity. General practitioners is recognised that 20 percent of all motor vehicle accidents in
are responsible for the initial diagnosis and ongoing New Zealand are caused by sleepiness.
management of CAP.
1
Central Region’s Technical Advisory Services Limited. 2008. Health Needs Assessment for the Central Region District Health Boards http://www.centraltas.co.nz/
LinkClick.aspx?fileticket=gZrLnFnbOAI%3D&tabid=63&mid=430
2
Martin P, Glasgow H, Patterson J. 2005. Chronic obstructive pulmonary disease (COPD): smoking remains the most important cause. In. The New Zealand Medical
Journal. Ed. 118/1213 http://journal.nzma.org.nz/journal/118-1213/1409/
3
Ajwani S, Blakely T, Robson B, Tobias M, Bonne M. 2003. Decades of disparity: Ethnic mortality trends in New Zealand 1980-1999. Wellington: Ministry of Health
and University of Otago.
4
The Asthma Foundation http://www.asthmafoundation.org.nz/in_new_zealand.php

R Respiratory
Curriculum for
Medicine
General Practice
Smoking is a significant contributor to respiratory New Zealand public health strategies targeted at reducing the
disease in New Zealand and is a major contributor to burden of respiratory disease are delivered through general
developing COPD and lung cancer.5 Studies in 2010 found practice. This includes childhood vaccination programmes and
approximately one in five adults (21.0 percent) were current those for adults, including influenza and pneumococcal disease.
smokers.6 Smoking rates are the highest among Ma-ori, at
44 percent – over double the rate of smoking for the
non-Ma-ori population (18 percent).7 Almost half of Ma-ori
women smoke.8 This highlights the importance of providing
culturally appropriate intervention. The Government has set
a target of having a smokefree New Zealand by 2025 by
using policy tools, such as increased taxes on cigarettes,
to encourage smoking cessation. General practitioners
have a significant role to play in reducing our population
smoking rates and positively influencing these figures.
Communication
• use appropriate verbal and non-verbal communication • identify the patient’s attitudes and beliefs about smoking
skills to obtain a history from patients, carers and other and modify or challenge these as appropriate
members of the multidisciplinary team, especially about
chronic disease and lifestyle
• employ a non-judgemental attitude when assessing the • negotiate a self-management plan for obstructive airways
patient’s knowledge and meaning of their illness and disease in partnership with the patient.
lifestyle choices
• employ empathy while managing acute illness, showing

clear communication with the patient, family and carers,
in times of crisis
5
Martin P, Glasgow H, Patterson J. 2005. Chronic obstructive pulmonary disease (COPD): smoking remains the most important cause. In. The New Zealand Medical
Journal. Ed. 118/1213 http://journal.nzma.org.nz/journal/118-1213/1409/
6
Ministry of Health. 2010. Tobacco Use in New Zealand: Key findings from the 2009 New Zealand Tobacco Use Survey. Wellington: Ministry of Health.
7
Ministry of Health. 2011. Ma-ori Smoking and Tobacco Use 2011. Wellington: Ministry of Health.
8
Ibid.

Respiratory Medicine R
Clinical Expertise
• discuss up-to-date knowledge of common and serious • apply guidelines for the emergency hospitalisation
respiratory tract conditions and their management of patients with acute respiratory illness to help reduce
preventable deaths
• use apparatus and investigative tools associated with • recognise the indications for urgent referral to specialist
respiratory conditions and appropriately interpret results services in cases of suspected lung cancer
• manage primary contact with patients with respiratory • apply up-to-date knowledge of respiratory disease
conditions prevention techniques
• use an evidence-based approach to antibiotic prescribing • assess, investigate and manage infective respiratory
for respiratory infections conditions
• recognise and refer appropriately patients with interstitial • undertake further training in procedural skills, such as
diseases chest drain insertion, where required based on population
and geographical area.
Professionalism
• be empathetic and compassionate towards patients with • employ culturally safe practice when assessing patients of
incurable, disabling respiratory conditions different ethnicities.
• treat respiratory conditions ethically and in a non-

judgemental manner
Scholarship
• monitor new technological advances that have • plan a career involving ongoing professional development
demonstrated improved health outcomes for people in respiratory conditions
with acute and chronic respiratory disease
• evaluate prevention strategies and clinical outcomes using • provide in-practice education on respiratory conditions
research and audit tools for the benefit of staff and trainees within the practice.

R Respiratory
Curriculum for
Medicine
General Practice
• discuss current population trends in the prevalence • examine the significant psychological and social impact of
of respiratory conditions in the community respiratory problems on the patient’s family, carers, friends,
dependants and employers
• coordinate care with other relevant primary health care • adopt an advocacy role in matters of environmental and
professionals occupation-related respiratory disease
• liaise with relevant allied health professionals to provide • understand the demographics, occupational health and
support and management of home-based oxygen therapy transport issues affecting their rural community, and plan
when required care of chronic and acute respiratory problems
appropriately.
Management
• work collaboratively within a team, or as team leader, • understand the impact of how the health service is
to provide appropriate care to patients with chronic organised locally and nationally, and how any variation
respiratory disease in resources and facilities may affect delivering health
care for respiratory illness.
• contribute to staff development and training

• Rural - Page 138

Rheumatology R
Rheumatology
Rheumatological problems produce a
significant burden on the New Zealand
health care system. Generally more
common in older people, it is likely that
with New Zealand’s ageing population
rheumatological problems will become
more prevalent, particularly gout and
osteoarthritis.
However, younger people are also affected, and Additionally, New Zealand has a rich sporting tradition
adults of working age (between 15 and 64 years) and, unfortunately, many forms of sport may lead to
represent 54 percent of the 530,000 people estimated long-term problems of osteoarthritis which a general
to have arthritis in New Zealand.1 The general practitioner is required to know about and be able to
practitioner is well positioned to reduce the burden manage competently.
this will place on patients and the health care system
by providing early diagnosis, prompt initiation of Rheumatological medicine is an area that involves
treatment, ongoing management and appropriate multiple drugs with the potential for significant side
referral for joint replacement. effects, often used for elderly patients. A thorough and
contemporary knowledge of pharmacology is essential
Arthritis is New Zealand’s leading cause of disability and to minimise the risk posed by polypharmacy.
the resulting reduction in physical activity, functional
restriction and untreated pain produce psychosocial The care of patients with rheumatological disease
changes affecting a patient’s personal relationships, frequently involves a multidisciplinary team, including
employment and overall quality of life. physiotherapists, occupational therapists and other
health care practitioners. The general practitioner
Gout is one of the most common forms of arthritis in occupies a central role in coordinating care as well
New Zealand with up to one in 10 Ma-ori men and one as ensuring the patient’s rights, dignity and self-
in six Pacific men living with gout.2 Chronic gout is determination are preserved. It is essential that the
preventable and is closely linked to other causes of general practitioner practises in a collaborative way,
mortality, such as obesity, hyperlipidaemia, diabetes respecting the various individuals who constitute the
and hypertension which increases cardiovascular multidisciplinary team.
risk. A general practitioner can play an important
part in destigmatising gout and promoting diet and By direct intervention and promoting self-
lifestyle changes. management strategies, the general practitioner has
an important role in managing these conditions. They
Rheumatologic disorders may provide clues to continue to increase in incidence and prevalence with
serious underlying medical conditions. The general our ageing population and poor health, secondary to
practitioner needs to maintain a broad approach to obesity and poor lifestyle choices.
evaluating new rheumatological symptoms and signs.
1
http://www.nzdoctor.co.nz/un-doctored/2011/july-2011/13/new-campaign-highlights-surprising-faces-of-arthritis.aspx
2
http://www.healthnavigator.org.nz/health-topics/gout/

R Rheumatology
Communication
• distinguish the different presentations of pain, obtain • communicate where appropriate, in conjunction with
a detailed pain history from the patient and, where the patient, with wha-nau/family, carers and employers
appropriate, from wha-nau/family members, carers to promote accurate disease monitoring and to enable
and employers rehabilitation plans.
• employ empathy and motivational interviewing skills

to help develop a sound therapeutic partnership with
the patient
Clinical Expertise
• take a comprehensive history, including identifying urgent • formulate a comprehensive management plan that may
and emergency symptoms, and important psychosocial include more than one health care provider
stressors on rheumatological conditions
• distinguish specific rheumatological conditions across • understand indications for and maintain competency
different populations in joint aspiration and injection appropriate to general
practice
• show awareness of the issue of somatisation (bodily stress • enable the patient to realise self-help strategies,
syndrome), where musculoskeletal symptoms may have a with the support of community resources
psychological basis
• organise investigations, interpret the results and propose • prescribe appropriately for treatment and pain
a rationale for further investigations to aid diagnosis of management in rheumatological conditions, describing
common rheumatological conditions the risks and benefits of medications.

• Health and Work - Page 80
• Musculoskeletal - Page 103

Rheumatology R
Professionalism
• support patient self-determination, and a patient’s right • employ the principles of informed consent before
to seek alternative and complementary therapies while embarking on any procedures
advocating best practice and patient safety
• employ empathy and compassion towards patients with • evaluate the role that ethnicity has on disease prevalence
incurable, disabling or painful rheumatological conditions and presentation, access to health services and clinical
outcomes.
• maintain premises and equipment that comply with

recognised codes of access and safety, particularly for
invasive procedures
Scholarship
• use evidence-based clinical decision-making when • adopt an evidence-based approach to practice and quality
managing patients with rheumatological problems improvement through research and audit
• teach and train staff and trainees for the benefit of patients • undertake ongoing medical education including, where
relevant, specific manual and injection techniques that are
useful to control pain and improve function.
• describe indications for referral within a suitable timeframe • examine the effect of increasing rurality of the community
to the most appropriate health care practitioner on disease presentation, access to health services and
clinical outcomes, and seek to reconcile any significant
differences
• provide leadership in the ongoing coordination of • work collaboratively with rheumatologists to address
multidisciplinary care for patients with rheumatological the increased cardiovascular risk associated with some
conditions when required rheumatological conditions.
Management
The GP will demonstrate the ability to appraise effective and appropriate care provision and health service use and in so doing
avoid investigations or treatments that are unlikely to alter outcomes.

R Rural
Rural
Rural general practice is defined by
the distance between the rural practice
environment and the resources of the
nearest urban centre, whether that is the
base hospital, hospice, community mental
health service, advanced ambulance
services, alcohol and drug service, home
support agencies and so forth. However,
the distance is not just geographic; it is
also cultural, economic and perceptual.
Rural New Zealand has characteristics and challenges that New Zealand is not a large country, and few rural communities
influence what health services are needed and how they are will be more than two or three hours from a secondary hospital,
delivered. These include large distances and geographical but mountainous geography and extreme weather events can
features that affect the ease of access to health services. quickly isolate an area. Similarly, distance and geography may
Small, isolated populations and higher levels of deprivation, make it difficult for rural people to access even their local health
which are closely associated with poor health status, are services, let alone travel to centralised secondary or tertiary
a feature of some rural regions and also in otherwise more services, especially those on low incomes or with chronic health
affluent rural communities. problems. Many older patients will choose to stay close to
home and family, cared for by their local health professionals.
In rural New Zealand, a larger proportion of Ma-ori are in high
deprivation areas than are Ma-ori in urban areas. There is Rural doctors must be true generalists; able to work
a direct correlation between rural areas with high levels of independently in an extended general practice role,
deprivation and the proportion of Ma-ori in the community.1 providing ‘birth to death’ care for their patients. They work in
environments which their more urban counterparts do not,
The extra travel costs that rural people incur make access such as at road accidents, and provide safe and effective pre-
to primary health care services particularly difficult for the hospital care and transfer for patients who require admission
people of rural communities. Service delivery in rural areas to the base hospital.
must focus on providing comprehensive primary health care
for rural communities.2
1
Rural Health – Challenges of Distance – Opportunities for Innovation; National Health Committee; January 2012 www.nhc.health.govt.nz
2
Rural Health – Challenges of Distance – Opportunities for Innovation; National Health Committee; January 2012 www.nhc.health.govt.nz

Rural R
Many rural general practitioners are also vocationally registered A doctor fills a vital role in a rural community, bringing with it the
as ‘rural hospital doctors’, managing inpatients in their local satisfaction of knowing they are really making a difference to the
rural hospital, which adds a whole dimension to their ability to lives of individuals and the community. But they also face the
care for their patients. challenges of availability and visibility, along with issues of social
and professional isolation.
Communication
• communicate and consult with sensitivity to particular • communicate clearly with patients, their families/wha-nau
rural issues including difficulty in accessing some services and colleagues around decisions to transfer to the base
due to work, distance and cost constraints, diagnostic hospital or manage locally
uncertainty, and patients’ wish to receive care close to
home and family
• communicate with local community support and • work in teams, and treat colleagues from all disciplines in a
resources, with members of the primary care team, which respectful and inclusive fashion
may include rural hospital staff, and emergency services
• provide telephone consultation and management advice • communicate and maintain supportive relationships
for patients in remote situations with colleagues at the base hospital.

R Rural
Clinical Expertise
• deliver clinical decision-making in a rural context • initiate treatment for a wide range mental health conditions,
and manage uncertainty conduct monitoring and develop knowledge of local
resources for psychological treatments and support
• manage acute medical presentations in a rural setting, • understand risk assessment, and appropriate strategies
including appropriate pre-hospital interventions, such for managing self-harm in a rural situation
as coronary thrombolysis
• manage acute paediatric presentations, including • provide ongoing care post-hospital discharge
neonatal resuscitation
• manage acute trauma, such as wounds, dislocations • provide care for patients that extends to admission to
and fractures, including conscious sedation and regional a rural hospital for appropriate conditions, in-patient care,
anaesthesia, and pre-hospital trauma care discharge planning and follow-up post-discharge
• manage acute obstetric emergencies and work in a team • provide comprehensive palliative care and end-of-life
with a midwife to manage these emergencies care, including managing uncertainty around diagnosis
and disease progress, and some procedures, such as
paracentesis and pleural effusion drainage
• update and maintain a procedural ability to support • recognise their own limitations so that management
the extended skills required, including more difficult IV will be limited to safe and quick transfer of care.
cannulation, intra-osseous access, chest drains and
airway management
• manage acute psychiatric emergencies, including

de-escalation techniques, restraint, emergency sedation
and transport, within the criteria of the Mental Health Act

Rural R
Professionalism
• understand the pressures to work outside their • maintain individual probity and public behaviour in a
competency, manage uncertainty and recognise their manner appropriate to a small rural community
limitations, seeking advice and help appropriately
• recognise and manage the ethical dilemmas and • understand the self of the doctor, their role in and
challenges facing rural GPs, such as confidentiality interaction with the community, and how this affects
and conflicts of interest their family
• provide leadership within a rural health team and • care for themselves, their family and colleagues
community in an isolated area.
• maintain professional boundaries and confidentiality

in a rural community
Scholarship
• develop a commitment to career-long learning, identifying • teach and mentor future rural health professionals.
areas not only for their own professional development
but also those that will benefit the health care of the
rural community
• provide leadership in developing and improving the

local health service, including using e-health
• appreciate the unique role of general practice and • understand the health culture of their rural community,
the primary care service in a rural community including occupational health issues, demographics
and ethnicity
• discuss the demographic profiles of rural communities • establish relationships with other health providers
and their relevance to health care in the rural community.

R Rural
Management
• understand how a rural primary care team can function • understand and use different funding streams
effectively and the leadership role of the doctor
• manage the effective, safe and appropriate use of the • identify contents of, source and maintain and own a
team to meet the need of the rural population complete doctor’s bag for home visiting and out-of-hours
use
• make efficient use of a limited pool of skilled health • consider and employ appropriately different business
professionals in a rural area models in a rural environment.
This curriculum statement links to

all others in the series. Also see
rural additions in other curriculum
statements for further skills
necessary for rural doctors.

Sexual Health S
Sexual Health
‘Sexual health encompasses a total sense
of wellbeing in relation to one’s sexuality
and sense of sexual self.’1
This sense of wellbeing is relevant to
everyone, regardless of age, gender,
ethnicity, sexual orientation, mental or
physical ability, living circumstances or any
other determinant of health. It is, however,
an area often complicated by conflicting
personal beliefs and values, and public or
political controversy.
Older age groups are not exempt from poor sexual health had experienced more than five partners, with Ma-ori girls three
outcomes as life expectancy increases and people remain times more likely to be sexually active at 14 than their non-
well for longer. Rates of sexually transmitted infections such Ma-ori counterparts.5 Not surprisingly, New Zealand has high
as chlamydia, gonorrhoea, syphilis, herpes and warts, and HIV rates of teen pregnancy, unintended pregnancy and sexually
are increasing at a greater rate in those over 40 than under transmitted infections, particularly chlamydia, gonorrhea
40.2 Patients over 50 are one-sixth as likely to use condoms, and HIV.6 Global travel and internet relationships bring new
one-fifth as likely to have an HIV test and more likely to be challenges, as does the changing structure of families.
misinformed about sexually transmitted infections.3
Sexual and reproductive health services are provided by a
The age of first sexual intercourse is lowering markedly in range of organisations throughout New Zealand, sometimes
New Zealand4 and sexual activity is increasingly beginning at targeting particular demographic groups. Variations in funding
a younger age for many New Zealanders. One study of 654 arrangements and heightened concerns about confidentiality
Hawkes Bay students found up to 40 percent of young people can affect access to these services.
had engaged in intercourse by age 14. Of these, 20 percent
1
The Collaborative for Research and Training in Youth Health and Development Trust. 2011. “Youth Health”.
2
Bodley-Tickell A T, Olowokure B, Bahaduri S, White D J, Ward D, Ross J D C, et al. 2008. Trends in sexually transmitted infections (other than HIV) in older people:
analysis of data from an enhanced surveillance system. Sexually Transmitted Diseases, 84:312-317.
3
Levy B R, Ding L, Lakra D, Kosteas J, Niccolai L. 2007. Older persons’ exclusion from sexually transmitted disease risk-reduction clinical trials. Sexually Transmitted
Diseases 34(8):541-544
4
Ministry of Health. 2001. Sexual and Reproductive Health Strategy.
5
Fenwick R, Purdie G. 2000. The sexual activity of 654 Hawkes Bay fourth form students. NZ Med J 460-3.
6
Ministry of Health. 2001. Sexual and Reproductive Health Strategy.

S Curriculum
Sexual Health
General practitioners are in the ideal situation to deal with

sexual health as part of the overall health and wellbeing
of their patients. Sexual health is interwoven through the
complexities of our patients’ lives, alongside changing social
relationships, chronic illness and impairment, and increased
life expectancy.
However, irrespective of age and presenting concern,

many patients – and many GPs – are whakama (shy
or embarrassed) about sexual health issues. Strong
communication skills are an extremely important tool with
which to establish a respectful and trusting therapeutic
relationship. GPs have opportunities to provide information
that enables patients to make informed choices and take
responsibility for their sexual and reproductive health, from
adolescence through to later years.
Communication
• outline the guidelines and limits of confidentiality, • initiate contact tracing discussions and follow up as
including using translators appropriate in their area
• use appropriate language that does not discriminate • provide accurate, honest explanation and education
against age, gender, disability, sexual orientation or appropriate to the age and stage of the patient
personal beliefs and values, and be particularly aware
of cultural parameters that may surround sexual health
• take an appropriate sexual history • deal with issues that may be uncomfortable for the patient
and/or the GP.
• provide pre-test counselling, particularly for hepatitis

and HIV testing

Sexual Health S
Clinical Expertise
• perform a focused examination, being sensitive to the • initiate tests and referral for the investigation of subfertility
privacy of the patient and any cultural requirements,
and recognise that using a chaperone is a safe practice
for both GP and patient
• discuss and prescribe contraception across the • assess and manage erectile dysfunction
reproductive age range, taking into account WHO
categories, and accurately educate the patient or couple
on correct use
• screen, test, treat and contact trace those at risk of • identify and manage symptoms related to peri-menopause
sexually transmissible infections, referring when necessary,
and providing accurate and timely education
• apply screening principles for cancers of the breast, • remain vigilant for signs of abuse, violence or coercion
cervix and prostate and know who to refer to.
• explain local options for unintended pregnancy and

negotiate a timely plan, remembering that not all
unintended pregnancies are unwanted
Professionalism
• establish clear professional boundaries around • support a patient’s choice in pregnancy regardless of their
confidentiality within the practice team, particularly own view on contraception and abortion.
in rural communities
• maintain updated contact details and be able to set in

place clear guidelines and appropriate arrangements for
communicating with patients, such as giving results

S Curriculum
Sexual Health
Scholarship
• contribute to the development and oversight of nurse-led • use opportunities to attend professional development and
sexual health services within their practice or community, update themself and their team.
including providing supervision and training
• identify vulnerable groups within the practice population, • demonstrate awareness of the prevalence of STIs in their
recognising their varied needs community and within sub-groups of the practice
population, and screen accordingly.
• identify and use other providers of sexual health services in

their community, comparing the ways in which their
services may overlap or differ
Management
• develop and review standing orders for managing sexual • explain local and national screening programmes and
health consultations, including contraception, STI testing the process for managing recalls and follow-up within
and treating their practice.

- Page 38
• Family Violence - Page 69
• Travel Medicine - Page 147

Travel Medicine T
Travel Medicine
New Zealanders are a mobile population
and New Zealand is also a popular travel
destination, so travel-related consultations
are common in general practice. These may
be related to either inbound or outbound
travel, temporarily or permanently.
In February 2012 visitor arrivals numbered 259,100. Overseas Not all travellers are on holiday. Some will be working
trips by New Zealand residents numbered 116,400, the most overseas and those who will be away for extended periods
common destinations being Australia, US, Fiji, UK, China and in high-risk environments, or who make frequent journeys
Cook Islands.1 In February 2012 seasonally adjusted figures between New Zealand and other countries, will benefit from
showed a net loss of 400 migrants. However, of those who specialist advice.
moved permanently to New Zealand, 1,000 came from India,
900 from China, 400 from the UK and 300 from Malaysia.2 For inbound or returning travellers, it is important to know
where they have arrived from and the circumstances in which
For outbound travellers, it is important to have a clear they have lived before, or during, travel. Infectious diseases
understanding of what travel people have planned and the acquired during travel may not present immediately.
travel medicine issues that relate to their particular destinations.
Many people leave travel advice until too late or rely on advice For those with temporary visas, such as rural migrant workers
they have accessed via the internet. Though travel medicine or overseas student’s permits, access to funded services
consultations can be complex, they are often tacked on to is variable. To attain permanent residency or citizenship, an
the end of a visit, almost as an afterthought. Chronic disease immigration medical assessment may be required and this
management can be a challenge in another country and is often another role for the GP. However, some who are new
obtaining medication can be fraught with difficulty. to New Zealand bring with them significant health issues
that are not always apparent initially, particularly those who
Our desire for adventure tourism often sends us up high are refugees. With the added complexity of language and
mountains, into remote places, out on the ocean and to places cultural differences, fostering a mutually trusting therapeutic
where health care is nowhere near as comprehensive as relationship is vital.
the services we have in our own country. Though ACC may
provide some support for accidental injury, comprehensive
travel insurance that includes repatriation costs is essential.
1
Statistics New Zealand, International Travel and Migration: February 2012. http://www.stats.govt.nz/browse_for_stats/population/Migration/IntTravelAndMigration_
HOTPFeb12/Commentary.aspx
2
Ibid.

T Curriculum
Travel Medicine
Communication
• take a comprehensive pre-travel history, taking into • discuss situations or risky behaviours that may increase
account the means of travel within countries, as well the chance of contracting various diseases
as particular regions that will be visited
• explain the risks and benefits of preventive measures, • inform patients of investigation, management and any
such as immunisations, and administer these appropriately containment issues for conditions contracted while
travelling.
• always consider travel when taking a history of particular

illnesses that may be picked up overseas
Clinical Expertise
• use knowledge of or gain access to information on more • prescribe for the traveller going overseas
specialised travel medicine topics
• be familiar with immunisation requirements and specific • undertake a comprehensive immigration medical
preventive measures relating to travel examination
• investigate and describe the implications of important • describe the particular conditions that will have an impact
returning traveller issues on immigration to New Zealand.
Professionalism
• manage the patient requesting supplies for a traveller’s • allow adequate time to cover all the issues involved in a
first aid kit travel consultation
• identify which patients are required to see a travel medicine • describe the adequate storage of and protocols for travel-
specialist, recognising their own level of expertise related vaccines.

Travel Medicine T
Scholarship
• undertake further education in travel medicine • educate or encourage education of practice staff on travel
medicine consultations, as appropriate
• keep comprehensive notes on travel consultations to • record accurate details of immigration medical
ensure all risks are covered consultations.
• balance the risks and benefits for families/wha-nau visiting • discuss the cost versus benefit of travel medicine
relations in overseas countries with New Zealand-born preventive measures
children
• recognise who are the local general practitioners and • establish a working relationship with an infectious
other health professionals with interests and skills in diseases consultant or microbiologist in the local or
travel medicine and refer where necessary regional area for discussion on presentations that require
their input.
Management
• describe and maintain ‘cold chain’ processes in the • consider the implications for the practice community of
practice communicable diseases that may have been brought in
from overseas.

• Gastroenterology - Page 73

W Curriculum
Women’s Health
Women’s Health
Women’s health has often been
synonymous with reproductive health, but
it is important to address women’s health
more broadly and within a social framework.
Women have special needs associated with
their roles, responsibilities and position in
society as well as their reproductive roles.
Women tend to be the major agents for improving health New Zealand has a strong rural environment. Many women
care in the community as they manage the health needs of work in the agricultural industry and are exposed to illness
the family. In New Zealand, many women are still the primary related to a rural way of life. Additionally, many older people
care givers in a family/wha-nau. Family/wha-nau is central to in rural communities are cared for by their extended families/
Ma-ori culture and the role of women is paramount. wha-nau with much of the caregiver’s role placed on the
woman, which brings an added dimension to an already-busy
While many of the problems with which women present are rural life.
not unique to women, the way in which they present and
need to be managed is often different from that of men. A The fertility rate for 2011 in New Zealand was 2.1 births per
number of health problems of women are preventable: key woman. Fertility rates are highest in women aged 30-34 years
factors influencing the health status of women in New Zealand and marks a significant shift from the 1960s when women
include smoking, alcohol consumption, physical activity, aged 20-24 had the highest fertility rates. 2011 recorded the
socioeconomic status and family violence. lowest number of live births since 2006, and is reflected in
women of all age groups having fewer babies.3 Fertility rates
Cervical cancer is one of the most curable of cancers and are still highest among Ma-ori women aged 20-24 and Pacific
yet 200 women develop it in New Zealand each year and 70 people show similar patterns with fertility being high in the
die from it. Ma-ori and Pacific women have a higher risk of early 20s but peaking in the years 25-29.4
cervical cancer and poorer survival rates, and yet this group
is less likely to obtain screening.1 Breast cancer is the most Although few general practitioners now deliver babies, they
common cancer in New Zealand women. The incidence of continue to have an important role in maternity care. A 2001
breast cancer is higher for Ma-ori than non-Ma-ori, and despite consumer survey revealed that, on finding out or suspecting
an improvement in survival rates during the period 1991–2004, that they were pregnant, 60 percent of women approached
Ma-ori women are more likely to die from it. This is attributed to a general practitioner, rather than a midwife or obstetrician.
a lower participation in screening programmes by Ma-ori.2 First-time mothers, Pacific women and women under 25 were
even more likely to approach a general practitioner.5
1
National Screening Unit, Cervical Cancer in New Zealand, http://www.nsu.govt.nz/current-nsu-programmes/1228.aspx
2
Ministry of Health, Cancer: New Registrations and Deaths 2007, p.76. Wellington: Ministry of Health. 2010.
3
Statistics New Zealand. 2012. Births and Deaths: Year ended December 2011 [online]
4
Statistics New Zealand. 2006. Age Specific fertility rates for the major ethnic groups [online]
5
http://www.health.govt.nz/publication/maternity-consumer-survey-2011

Women’s Health W
Before 2007, general practitioners were unable to provide The general practitioner’s care of women involves not just
government-funded pregnancy care unless they took on the managing the presenting problems but also prevention,
role of lead maternity carer (LMC), which involved intrapartum screening and holistic care in partnership with the female
care. In 2007, non-LMC first trimester care was introduced6 patient at critical moments in the life cycle, the workplace and
which allowed women to receive government-funded within her social role context.
maternity care from their general practitioner until the end of
the first trimester of their pregnancy by which time they were There are slightly more females than males in New Zealand
registered with their LMC. In addition, as a result of changes (51percent8), particularly among the adult population. As most
to the Referral Guidelines7 in 2012, midwives can now refer of the contacts that women have with health care providers
pregnant women with certain medical conditions to a general are with general practitioners, the way the general practitioner
practitioner for care of these conditions rather than being treats them and their concerns is of great significance to
required to refer them to a secondary care specialist. women and the health of the community.
Communication
• explain and discuss health issues relating particularly • take an appropriate sexual health history
to women to their patients and their families/wha-nau
• communicate with women of all ages, eliciting their • communicate the variety of issues that need to be
ideas, concerns and expectations during consultation discussed with women around antenatal and
and negotiating an effective management plan postpartum care.
6
http://www.health.govt.nz/publication/section-88-primary-maternity-services-notice-2007
7
http://www.health.govt.nz/publication/guidelines-consultation-obstetric-and-related-medical-services-referral-guidelines
8
Ministry of Social Development. 2010. Age and sex structure of the population: The Social Report. http://www.socialreport.msd.govt.nz/people/age-sex-structure-
population.html

W Women’s
Curriculum
Health
Clinical Expertise
• understand the pathology, clinical management and • discuss fertility issues as they relate to women with
epidemiology of illnesses relating to women patients and their families/wha-nau
• perform examinations and gynaecological procedures • discuss strategies to reduce the inequalities in health
relating specifically to women’s health that are safe to between Ma-ori and non-Ma-ori women
perform in the primary care setting, recognising that using
a chaperone is a safe practice for the patient and GP
• manage and prescribe medication relating to women’s • recognise obstetric or gynaecological emergencies
health issues and treat or refer appropriately
• discuss all aspects of menstruation throughout the life • explain local options in unintended pregnancy and
of the woman with patients and family/wha-nau negotiate a timely plan, recognising that not all unintended
pregnancies are unwanted
• recognise and be willing to discuss signs of abuse • undertake an antenatal consultation, taking into account all
in a non-judgemental manner and refer appropriately, the screening, management and lifestyle issues that require
understanding the importance of proactive enquiry full discussions, and referring for ongoing care as required.
Professionalism
• describe the use of chaperones and introduce them • consider privacy issues that may arise with electronic
appropriately to the patient notes that all staff have access to
• acknowledge professional boundaries that are likely to • provide advocacy for women patients, especially in relation
impact on the doctor–patient relationship, particularly to those suffering from family violence.
in relation to power, culture, gender and sexuality
• up-skill in areas relating to women’s health to meet the

needs of their practice population, such as ultrasound
scanning skills in rural areas

Women’s Health W
Scholarship
• audit their practice to ensure best practice for their female • promote and encourage staff training of increase service
patients is being achieved provision to women.
• undertake ongoing training to enhance skills in women’s

health
• refer to local and national community and allied primary • establish relationships with providers of obstetric care
care organisations, such as women’s refuge, to enable if they are not available in the practice
management of conditions relating to women’s health
• ensure adequate screening programmes are run for the • undertake self-care, especially for women balancing
practice population work and family/wha-nau.
Management
• follow practice policy on following up tests • describe protocols or policies in the practice for other staff
performing tests, for example nurses doing smear tests.
• educate their practice team about conditions relating

to the health of women

• Family Violence - Page 69
• Sexual Health - Page 143

ISBN: 978-0-9922456-1-0
© The Royal New Zealand College of General Practitioners, New Zealand, 2012
The Royal New Zealand College of General Practitioners owns the copyright of this
work and has exclusive rights in accordance with the Copyright Act 1994.
In particular, prior written permission must be obtained from the Royal New
Zealand College of General Practitioners for others (including business entities) to:
• copy the work
• issue copies of the work, whether by sale or otherwise
• show the work in public
• make an adaptation of the work as defined in the Copyright Act 1994.
April 2014

2014 Curriculum For General Practice

Uploaded by

Copyright:

Available Formats

2014 Curriculum For General Practice

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2014 Curriculum For General Practice

Uploaded by

Copyright:

Available Formats

Curriculum

02 Curriculum for General Practice

E nga- mana, e nga- reo, e nga- karangatanga maha

Greetings to all of us, and to those who have

www.rnzcgp.org.nz Curriculum for General Practice 01

The Royal New Zealand College of General

It is a dynamic, working document designed not only Tim Malloy

The RNZCGP Curriculum for General Practice 2012

02 Curriculum for General Practice

• Dr Samantha Murton – Curriculum Development Lead • GPEP medical educators

• Dr Rawiri Keenan – Registrar Representative • Primex examiners

• Sue Domanski – Education Advisor Training & Evaluation • Fellowship assessors

• Rhett Emery – Manager Vocational Training • College censors

Contributing members The Curriculum Review Committee is also grateful to the

• Dr Keri Ratima – Tumu-aki Ma-ori

www.rnzcgp.org.nz Curriculum for General Practice 03

04 Curriculum for General Practice

Syllabus Primex Blueprint

Thirty-one curriculum statements have been developed The

• integrative health care

www.rnzcgp.org.nz Curriculum for General Practice 05

The knowledge, skills and values identified in each of

They represent the vocational pathway to Fellowship of the

The syllabus identifies the learning outcomes to be achieved

Ongoing curriculum refinement by the College will be a

06 Curriculum for General Practice

• is personal, family/wha-nau and community oriented,

• is normally the first point of contact within the health system,

• makes efficient use of health care resources through

• develops a person-centred approach, oriented to the

• has a unique consultation process that establishes a

• is responsible for the provision of longitudinal continuity

www.rnzcgp.org.nz Curriculum for General Practice 07

The College is committed to understanding the determinants of

08 Curriculum for General Practice

www.rnzcgp.org.nz Curriculum for General Practice 09

Evidence-based medical practice

The original definition of evidence-based medicine focused

The educational philosophy underpinning the curriculum

The curriculum recognises the need of adult learners for clarity

Reviewing and updating the curriculum

10 Curriculum for General Practice

General practice education reflects the complexity of the

www.rnzcgp.org.nz Curriculum for General Practice 11

• inter-professional learning Curriculum delivery will be underpinned by formative

12 Curriculum for General Practice

5. Context of General Practice 22

In domains 3, 4 and 6, further competencies have been

A general practitioner who achieves Fellowship of the

www.rnzcgp.org.nz Curriculum for General Practice 13

Engaging in ethical practice is a conscious component of

14 Curriculum for General Practice

• manage consultations efficiently within time constraints

www.rnzcgp.org.nz Curriculum for General Practice 15

They competently manage common health needs while being

16 Curriculum for General Practice

• use planned and opportunistic approaches to provide

www.rnzcgp.org.nz Curriculum for General Practice 17

18 Curriculum for General Practice