Little Sick, Big Sick

GPs, Pharmacists, and Nurse Practitioners have roles in primary care – but it’s not either or. It’s both. They shouldn’t be competing against each other. They are not the same.

Professor Claire Jackson has her views and expresses them eloquently below. My views are:

GPs provide excellent care and deliver fantastic value to their patients and to Australia.

Other health practitioners also have the potential to provide excellent care to people at a different level and in different ways. They may very well provide care to many many people that GPs don’t already see. They’re not GPs.

If you want to be a doctor and further go on to specialise in General Practice, becoming the Specialist Urban or Rural Generalist, there is a pathway for this. It’s Medical School, Internship, and Fellowship Training.

Let’s look at some communities and people that aren’t well looked after under the current system like ATSIs, people with an intellectual or physical disability, and the homeless.

These are the groups Nurse Practitioners and Pharmacists should be working with GPs and existing Primary Care networks to get better outcomes happening.

Professor Jackson, Australian Doctor 2009

IT’S as pervasive and globally contagious as swine flu — and potentially as deadly in a susceptible population.

I am talking about the growing conventional wisdom that general practice is a basic combination of lots and lots of ‘little sick’ (so much more easily and less wastefully dealt with by nurses) and the far less frequent ‘BIG SICK’ (which requires the calling forth from the back room of the big gun, highly-trained, clever-dick, scarce-in-supply GP).
Such wisdom has led to the situation in the UK where nurse-led clinics in hypertension, asthma, lipid management, COPD, diabetes, and so on are increasingly the order of the day. In this utopian setting, issues of patient concern are dismembered carefully into presenting ‘body parts’, where nurse-led protocols can be used to define management algorithms. The GPs remain available for those patients who defy the guideline, or where the nurse perceives they require professional referral.

Naturally, there are quite a few problems with this approach, particularly for a country that leads the WHO/OECD league tables for longevity, patient GP satisfaction, and preventable death rates.

 

The first problem is this myth is based on a totally flawed assumption. The ill-defined nature of primary care presentations makes accurate diagnosis and problem definition the most challenging of all medical specialties. GPs and practice nurses are greatly offended by the oft-heard view that general practice is mostly ‘vaccinations, coughs and colds and protocol-driven chronic disease management’. When is ‘diarrhoea’ due to viral infection, and when to coeliac disease, alcoholism or rectal cancer? When is ‘cough’ due to parvovirus rather than oesophageal disease, anxiety, sarcoid or lung cancer? When is ‘nausea’ viral and when secondary to polypharmacy, renal dysfunction, drug abuse, cholecystitis, depression or Barrett’s oesophagitis?

The skill involved in accurately and rapidly diagnosing problems in general practice is profound, requires complex clinical reasoning, and a significant skill base. It is entirely inappropriate to triage most primary care patients into anatomical group assessment clinics based on presenting complaints. To do so is to risk diagnostic delay, confusion and inconvenience for the patient and often significant expense. Patients deserve and expect the best qualified person to work with them in the all-important problem definition and initial management decisions. In our world, that is the GP/practice nurse team in combination.

The second problem with the myth of little sick/big sick is the absence of any pretence at patient-centredness. What patient wants to book appointments at predetermined clinic days/times for between one and four separate comorbidities? How do they fit that easily with competing demands from work, family and carer needs?

Third, the myth ignores the significant and growing prevalence of comorbidity in primary care. Recent data has charted the growing increase in disease co-morbidity in our communities. Such presentations predicate a skilled generalist approach. General practice is trained and skilled for this and is increasing its capacity to deliver.

Fourth, the myth contributes to the decimation of continuity of care.
Stephen Campbell’s paper in the New England Journal of Medicine
in July this year chillingly chronicled the demise of continuity of care in UK general practice since the 2003 reforms. Such data allows Australian communities, governments and health professionals a sneak peek at the consequences if we emulate this model.
The fifth problem in this myth is the complete antithesis of the consultation and reform agenda advanced by the National Health and Hospitals Reform Commission and National Primary Care Strategy. Throughout the reform process, consumer groups overwhelmingly said they wanted comprehensive, co-ordinated, integrated, patient-centred care delivered to themselves and their families — not a fragmented ‘little sick/big sick’ approach.

 

Finally, there is no evidence for enhanced benefit. The Cochrane Collaboration summary on the equivalence of GP-led and nurse-led care has more disclaimers than a set of K-Tel steak knives. Most damning is the statement that these findings “should be viewed with caution given that only one study was powered to assess equivalence of care, and many studies had methodological limitations”.

So, Australian policy-makers, reformers and governments beware — 50 years of general practice hard slog has resulted in international benchmarking for key health outcomes, and unsurpassed general practice patient satisfaction. Over the past five years, the GP/practice nurse/allied health practitioner team has progressed a collaborative general practice team that has taken this even further, with the absolute preservation of continuity of care. This is the model Australian consumers have overwhelmingly endorsed.

Unravel this, without clear benefit and evidence, at your peril.

 

This article is based on a speech Professor Jackson made at the RACGP GP09 conference.

Professor Jackson is head of the discipline of general practice at the University of Queensland.

 

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stick with doctors 😎

 

 

 

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

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Dr Chrissy Psevdos

 

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Dr Katherine Astill

(on Maternity Leave from August 2018)

 

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Partridge Street General Practice has better options for your pain – 1

The federal Centers for Disease Control and Prevention recommends that prescribers avoid opioids for most chronic pain.

Read more here:

Partridge Street General Practice is proud to be a low prescriber of opioids, narcotics, and other medications that have NOT been shown to be effective and safe. We will be happy to discuss better options with you right here.

Our team – here for You!

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

dr gareth boucher

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Abby Mudford

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

dr chrissy psevdos at Partridge Street General Practice

Dr Katherine Astill

(on Maternity Leave from August 2018)

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Like synchronised swimming, general practice is much harder than it looks

Dr Liz Sturgiss is a GP from our nations capital. Those of you who know me will know that for me to recommend something from Canberra, it’s got to be good. This is. Grab a cup of tea or coffee and settle down for a good read from a great GP on the best job in the world. Here’s an excerpt to whet your appetite and read on at the link.

 

The senior GP in full flight practising quality medicine in a busy clinic looks like they are doing a simple job, but you can only see the surface. They make it look easy.

General practice is a specialty that cannot be done by anyone else “just as well”, even though it’s not very flashy and sometimes seems simple.

Without an underwater camera, much of general practice, like synchronised swimming, remains a mystery.

 

 

Read on here

 

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Our GPs at Partridge Street General Practice

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Welcoming Dr Abby Mudford to Partridge Street General Practice

dr abby mudford blue at Partridge Street General Practice

 

 

Partridge Street General Practice is proud to welcome Dr Abby Mudford to our team! She’s a graduate of the University of Auckland and commenced her specialist General Practice training in February 2018 after three years of post-graduate hospital work at Flinders Medical Centre. Dr Abby has special interests in surgery, skin medicine, and gastrointestinal diseases.

 

 

 

 

 

 

 

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

This means that the GPs at Partridge Street General Practice are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

 

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Teaching Practice of the Year

 

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.
We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

 

Dr Abby Mudford is a valuable member of our growing Clinical Team and she’s keen to hit the ground running here at Partridge Street General Practice!

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

 

DR NICK TELLIS

 

Your Specialist In Life

DR NICK MOUKTAROUDIS

 

dr nick mouktaroudis at Partridge Street General Practice

DR GARETH BOUCHER

 

dr gareth boucher

 

DR PENNY MASSY-WESTROPP

 

 

Dr Penny Massy-Westropp

DR MONIKA MOY

 

 

Dr Monika Moy

 

DR ABBY MUDFORD

 

dr abby mudford at Partridge Street General Practice3

DR CHRISSY PSEVDOS

 

dr chrissy psevdos at Partridge Street General Practice

Welcoming Dr Chrissy Psevdos to Partridge Street General Practice

dr chrissy psevdos at Partridge Street General Practice

Partridge Street General Practice welcomes Dr Chrissy Psevdos who has kindly agreed to locum with us while Dr Nick Tellis is on Paternity Leave. She is a quality GP with a Fellowship of the RACGP and many years of experience. She has a passion for people and can assist you with all of your health needs.

Her first day with us is Tuesday 24th July and you can book an appointment with her right here.

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.
We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

She is keen to hit the ground running with the rest of our Great Team here at Partridge Street General Practice! We look forward to having Dr Chrissy Psevdos as part of our growing Clinical Team and sharing her experience with us and our valued patients.

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

 

DR NICK TELLIS

 

Your Specialist In Life

DR NICK MOUKTAROUDIS

 

dr nick mouktaroudis at Partridge Street General Practice

DR GARETH BOUCHER

 

dr gareth boucher

 

DR PENNY MASSY-WESTROPP

 

 

Dr Penny Massy-Westropp

DR MONIKA MOY

 

 

Dr Monika Moy

DR CHRISSY PSEVDOS

 

dr chrissy psevdos at Partridge Street General Practice

Alternative…Patients – #kickback edition

Thanks George Forgan-Smith 😉

 

 

It’s the week after the RACGP AKT and KFP exams for some and before a busy week for others. You may be a little flat and the world may seem a bit chaotic at the moment so I thought I’d take a minute to remind us all of how good we have it in Australian General Practice.

 

What are some of the little things your patients have done for you? (#kickbacks 8-)) These are three that come to mind for me:

 

 

 

Sugar free, too 👍👍👍

 

 

 

When the person I squeezed in for an appointment because they were ‘really ill’ stopped the consult to give me a (sugar free 👍) lolly when I was coughing at the end of a long day with lots of sniffling kiddies.

 

 

 

A Series of Unfortunate Events

 

 

 

A lovely painting I got for ‘mates rates’ after helping someone through a ‘series of unfortunate events’ (see the main picture!)

 

 

 

Needs banana for scale 🍌

 

 

 

3. A fantastic steak dinner cooked for me when I was spotted sneaking out of the practice clutching a bag of chips on a big on call night.

 

 

 

 

 

What little things have your patients done for you? 

 

 

Sunset at Glenelg

 

 

Take a moment to have a think and feel grateful – we really do have the best job in the world!  👍

 

Dr Nick Tellis is passionate about great general practice. He’s a proud GP, beachside Adelaide practice owner, and a happy new father. He blogs at www.partridgegp.com when not administrating on GPDU.

 

Contact Dr Nick Tellis at drnt@partridgegp.com.au or 0882953200 if You would like to be:

part of a great team where everything is set up to help you help others

helping great patients

near the beach

working fewer hours and earning more with private billing

 

 

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GPs want clinical handovers, not discharge summaries

PartridgeGP is all about professional, comprehensive, and empowering General Practice care by our GPs. When we refer our valued patients for treatment elsewhere we promote the same high standards, values, and communication  that we provide. A letter, referral, or phone call is just part of the standard PartridgeGP service – it’s good clinical handover. Dr Nick Tellis recently collaborated with some excellent GPs in writing an article for the Medical Journal of Australia’s online Insight Blog on ways to improve communication during these times and stressing the importance of better clinical handover. It’s another one of the ways PartridgeGP provides Better Healthcare for our valued patients. Read on.

 

This is the third article in a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group that is based on GP-led learning, peer support and GP advocacy and was originally published at the Medical Journal of Australia (MJA) Insight Blog here

 

“PASSING the baton” describes what health care professionals try to achieve as care of patients is transferred between providers in our complex health care systems. The topic of safe and effective clinical handover comes up repeatedly in discussions on GPDU.

 

It is apparent that the impacts from delayed or poor clinical handover on patient care across the country are significant, under-reported, and have a profoundly negative effect on the care patients receive.

 

Dropping the baton

 

First-hand accounts of treatment delays, duplication of testing, medication errors, and unplanned readmissions are frequently discussed by GPs. Recent clinical case discussions have included a patient in palliative care being transferred to a hospice on a Friday afternoon with no clinical handover, and a 3-month delay in the completion of a discharge summary for a truck driver who was admitted with a myocardial function.

 

The safety concerns related to poor clinical handover are not new: it’s a problem the health care industry and doctors as a profession have been grappling with for decades. Poor clinical handovers are wasteful of limited resources. How can we improve patient outcomes and “drop the baton” less often?

 

Rules of the game

 

The National Safety and Quality Health Service Standards (NSQHS) and the Australian Commission on Safety and Quality in Health Care (ACSQHC) define clinical handover as; “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group”. Appropriate clinical handover is a requirement of the NSQHS. The ACSQHC notes the importance of “transition of care” that “ends only when the patient is received into the next clinical setting”. The Australian Council on Healthcare Standards EQuIP National Standard 12, in particular, specifies the planned provision of transfer information, including results of investigations.

 

Breakdown in the transfer of clinical information has been identified as one of the most important contributing factors in serious adverse events, and is a major preventable cause of patient harm.

 

Why is clinical handover from hospitals to GPs done so inconsistently for patients transitioning from our major private and public institutions? The benefits of passing the baton smoothly are clear. It’s time to coach the team to get it right.

 

Timing is everything

 

Health services continue to debate the appropriate timeframe for communicating with the GP who is continuing the patient’s care. Timeliness of clinical handover is a topic that comes up frequently. Hospital targets for transfer of care communications vary widely. A recent discussion on GPDU identified several targets within one small geographical area, ranging from “at the point of discharge”, “48 hours after discharge” and “5 days after discharge”.

 

GPDU dragon head-3

 

The reality is that few patients leave hospital with an effective clinical handover. Some will be received within the hospital’s current targets; however, many clinical handovers are not received for weeks, months or, as one post highlighted, years after the patient care is transferred. Some never occur.

 

Many GPs are asking whether these targets are consistent, appropriate, acceptable or safe. A robust discussion took place after GPs were approached to complete a survey that included a question asking what conditions should warrant a discharge summary on discharge, and what the acceptable timeframe for receiving a discharge summary should be.

 

The overwhelming consensus was that the gold standard should be clinical handover on discharge for all patients. Many were frustrated that this question even needed to be asked. Some GPDU members wondered whether this was a trick question aimed at moving the goalposts further away from quality patient care.

 

Services promoting clinical handover to GPs on discharge were highlighted. The Sunshine Coast Hospital and Health Service was identified as a provider that was actively trying to effect positive change. They received plaudits from the wider GP community simply by having a discharge summary management policy specifying complete discharge summaries available at the time of patient discharge.

 

It is well known in GP circles that starting late ensures that you will run late all day. Timely discharge summaries aren’t late. Timing is everything when you want to be a frontrunner.

 

Don’t fumble the handover

 

The consensus among GPs is that well timed, efficient, effective and safe clinical handover, at or before the point of transition of care is essential. Alternative strategies risk adverse outcomes. Clinical handover must be a standardised process between clinicians.

 

Returning to the athletics track, we can see a clear difference between a handover, a throw, and a drop. Highly trained athletes accept nothing less than a smooth handover – nor should highly trained clinicians. Delegating the handover to non-clinicians, including nurses and medical students, is not good enough. Supervision and ongoing coaching of clinicians is vital.

 

The baton is passed between people not machines

 

Imagine the difference electronic systems could make to this smooth handover. Sadly, this smooth electronic handover exists only in the imagination.

 

In the real world, GPs are grappling with being thrown links to hospital electronic records through systems such as “The Viewer”. Investigations are likely to be uploaded (after a delay) to MyHealthRecord. These are raw data, unfiltered and disorganised, and more of a throw than a handover. Being thrown raw data and being expected to catch them in this way is akin to a hospital doctor being given the login to the GP clinic’s patient management system and being expected to extrapolate a referral.

 

Personal bests are set; medals are won

 

The late Sir Roger Bannister ran the 4-minute mile and reset the expectations for all that followed him. GPs and their discussions can highlight outstanding clinical handovers and applaud initiatives and hospitals that are doing it right. Feedback and constructive criticism can be passed back to hospitals that are raising the bar. Medal-winning performances show the possible and provide a model for future improvement. GPs are uniquely placed to spot the talent and report the score widely and rapidly.

 

Eyes on the prize: what’s the next goal?

 

If we can normalise the clinical handover to young GPs who are the future of general practice, it will encourage them to demand it of their hospitals.

 

Hospitals are incredible places, but the aim is for patients to return home to their communities and trusted GPs. They come home. Their GPs are waiting, willing and able. We can do better, and we will. We extend an open hand to our amazing hospitals. Pass us the baton – we won’t drop it.

 

clinical handover

 

Dr Katrina McLean is a Gold Coast-based GP, Assistant Professor in the School of Medicine and Health Sciences at Bond University, and a GPDU administrator.

 

Dr Michael Rice is past-president of the Rural Doctors Association of Queensland, an educator of students and registrars, a long term resident and rural GP in Beaudesert. He’s a keen user of social media.

 

Dr Nick Tellis is passionate about great general practice. He’s a proud GP, beachside Adelaide practice owner, and a happy new father. He blogs at www.partridgegp.com when not administrating on GPDU.

 

Contact Dr Nick Tellis at drnt@partridgegp.com.au or 0882953200 if You are a Great GP and want a Better Place to practice great medicine!

 

 

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Partridge Street General Practice is Proud to be a Teaching Practice

Quality accredited by AGPAL

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx and our local Medical School at Flinders University.

 

 


 

 

This means that the GPs at Partridge Street General Practice are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

Teaching Practice of the Year

 

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.
Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.
We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

Professional. Comprehensive. Empowering.

 

See just how we do it here.

 

Good luck to all the fantastic GP trainees out there!

 

 

Contact Dr Nick Tellis at drnt@partridgegp.com.au or 0882953200 if You are a Great GP and want a Better Place to practice great medicine!

 

Why is Partridge Street General Practice a Teaching Practice?

The word “doctor” is derived from the Latin, docco, which means “to teach.”

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx and our local Medical School at Flinders University. Teaching is in the DNA of our GPs and so it is in the DNA of Partridge Street General Practice!

 


 

This means that the GPs at Partridge Street General Practice are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

Teaching Practice of the Year

 

IMG_20180618_135950_756
Ms Shantay Budz – First Year Medical Student at James Cook University

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.
We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

Professional. Comprehensive. Empowering.

Want to be part of this great team? Email Dr Nick Tellis at drnt@partridgegp.com.au or call on 0882953200

 

 

 

join the team