An article written by Brian McAvoy and published in the Medical Journal of Australia (2007; 187 (2): 115-117) regarding the key role of general practitioners in the prevention, screening, early diagnosis and referral of cancers, as well as the full spectrum of cancer care from prevention to palliation, including providing psychosocial support to patients and their families and carers, follow-up and detection of recurrence, and survivorship. 

This article, published in Australian Family Physician Volume 37, No. September 2008, examines the key role of the general practitioner and practice staff in providing integrated and coordinated care to cancer patients throughout their cancer journey.

Links to the Australian Clinical Cancer Treatment Guidelines section on the Evidence and Latest Treatment resources page.

Primary care/general practice is usually the first point of contact for people with early symptoms of cancer and plays a significant role in prevention, screening, follow-up after treatment and palliative care. However, there is still scope to expand the role of general practice in collaboration with cancer specialists.

Cancer Australia and CanNET have developed a specific resources to better support general practitioners (GPs) in the delivery of cancer care, including: 

• Medicare - helping you deliver comprehensive cancer care (PDF 1.12MB)
• Final Report: Role Redesign Primary Care - Shared Care Models of Cancer Treatment and Surveillance Post Treatment (PDF 227KB)
• Primary Care - Reducing Risk (PDF 188KB)
• Primary Care - Finding Cancer Early (PDF 181KB)
• Primary Care - Managing Cancer (PDF 182KB)
• Primary Care  - Networks (PDF 187KB)

A lack of information related to the safe administration of oral chemotherapy agents in the community setting for health care professionals, patients and carers was a service gap identified by stakeholders involved in the improvement of cancer care delivery, and so GICS developed Clinical Guidelines that address this gap, in order to:

1. Ensure health care professionals, patients and family have information available to them in relation to:

i. safe prescribing of oral chemotherapy agents

ii. safe handling of chemotherapy agents

iii. safe administration of chemotherapy agents

iv. safe disposal of cytotoxic waste

2. Act as a resource for health care professionals in providing information to patients and family

3. Provide a care pathway which is in alignment with best practice and the Worksafe Victoria, Jan 2003, Handling Cytotoxic Drugs in the Workplace.

Please note the guidelines are intended as a guide only.

The purpose of this paper is to clarify the role and purpose of clinical indicators and to outline The Royal Australian College of General Practitioners (RACGP) position on the use of clinical indicators in general practice and to enhance and inform the standards for general practice.
It will be used to inform a range of RACGP quality improvement programs including:

• the Quality Assurance and Continuing Professional Development Program
• the Standards for general practices
• advocacy submissions on general practice improvement
• safety and quality policy and project developments.

Australia’s Clinical Practice Guidelines Portal has been developed to help Australian clinicians and policy-makers access high quality, evidence-based clinical practice guidelines via a single entry point.

The Portal is an initiative of the National Institute of Clinical Studies, an institute of the Australian Government’s National Health and Medical Research Council as part of our mandate to build a healthier Australia.

The Portal links to clinical practice guidelines developed for use in Australian health care settings. Each guideline on this portal has been assessed according to rigorous selection criteria to help you find the type of guideline you are looking for.

It provides direct links to guidelines or to guideline developer websites. The majority of guidelines linked to are free, however in a few instances payment is required.

The site links only to Australian clinical practice guidelines. For public health and ethics guidelines approved by the NHMRC visit the NHMRC website, or for consumer health information visit the Australian Government’s HealthInsite portal.

The Guidelines for preventive activities in general practice (the Red Book) is a synthesis of evidence-based guidelines from Australia and international sources and provides recommendations for everyday use in general practice; including preventative activities at various stages of life and practical advice on what kind of screening and services should be provided to the general population. It also identifies high risk segments of the population that require different preventive services.

An adult chart and a childrens' chart are provided.

Of particular interest are Chapter 2, which focuses on genetic counselling for hereditary illnesses such as breast and bowel cancers, Chapter 7 focusing on prevention of chronic disease and Chapter 9 which focuses on screening and early detection of cancers.

Information for GPs regarding Medicare Benefits Schedule (MBS) primary care items that support primary care services to cancer patients, including:

• Chronic Disease Management (CDM)
• Multidisciplinary Case Conferences
• Medicare Health Assessment for Aboriginal and Torres Strait Islander People

A booklet to present current recommendations on screening for cancer and a useful reference tool for general practitioners who are confronted with cancer screening issues in their day to day practice. Eight common malignancies have been included in this review of screening recommendations: breast, cervical, colorectal, lung, melanoma, ovarian, prostate and testicular cancer.

Part 1 is concerned with definitions and distinctions between screening and ad hoc case-finding of malignant neoplasms.

Part 2 of the booklet deals with specific information regarding screening for each of the eight cancers.

Downloadable/printable quick reference guide available:

http://www.cancerwa.asn.au/resources/2010-06-28-recommendations-for-screening-for-specific-cancers-a4-card.pdf

A report produced following the Australian govenrment commitment to fund $5.6 million for cancer research including funding for increasing the role of primary carers in cancer prevention, detection, treatment and care.

A carer is someone who, without payment, provides support to a partner, child, relative, friend or neighbour who could not manage without their help. GPs and their teams are often the first point of contact for carers, uniquely placed to recognise that someone is, or is about to become, a carer, and to provide support, information and resources.

This resource suggests ways for GPs and their practice teams to support carers practically and emotionally, to monitor their situation and wellbeing, and to identify and resolve any issues that may arise at an early stage.

Primary care is seen as an increasingly important health care sector in the management of cancer in Australia. In "Towards a National Primary Health Care Strategy: Comments in response to Department of Health and Ageing discussion paper", the Cancer Council Australia/COSA provide recommendations for achieving improved cancer outcomes through primary care reform in response to the discussion paper by the Government‘s National Health and Hospitals Reform Commission and Preventative Health Taskforce.

Developed by the Royal Australian College of General Practitioners (RACGP), National Breast and Ovarian Cancer Centre (NBOCC) and Cancer Council Australia, Cancer Screening is an evidence‐based, educational module which examines the criteria used to decide which cancers are suitable for a population screening program, including the overall potential benefits and harms. Cancer screening covers general screening principles and how they apply to population‐based screening for cervical, breast and bowel cancers.

The Category 1 Activity Cancer screening active learning module (ALM) is approved by the RACGP QI&CPD Program for 40 Category 1 points in the 2011–2013 triennium.

For further information please see the general practice and cancer screening factsheet.

This 2nd edition of Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting has been created by a multidisciplinary team of experts for use by general practitioners, practice nurses and practice staff. The guidelines are intended to be a practical resource designed to strengthen prevention activities in general practice. The expert team has created an up-to-date prevention approach and identified effective prevention activities for general practice.

The book focuses on factors including:

• Targeting of preventable diseases
• Implementation of prevention activities and strategies in our practices
• Being effective and efficient to improve quality and reduce cost
• Utilisation of information technology and management systems
• Teamwork within the practice
• The use of community resources and support where practical
• The partnership between the general practitioner, the patient, practice staff and other health professionals.

Other resources to assist in the implementation of the guidelines are available here and include:

A PowerPoint presentation demonstrating the importance of cultural training containing practical information for General Practitioners caring for Indigenous Australians.

A two page guide for general practitioners for the assessment and management of lung cancer.

The BMJ Group offers a number of interactive, online continuing professional development modules, designed to help Primary Carers stay up to date with training, practice and appraisal. Offering some free modules, most modules can be accessed via the purchase of an annual subscription.

The GP CPD, Practice Nurse CPD and Other Health Professionals CPD modules include 25 oncology themed learning modules including:

• Basal cell carcinoma: diagnosis and treatment
• Cancer and genetics: an up to date guide
• Caring for patients with bowel symptoms
• Cervical cancer vaccination: an up to date guide
• Colon cancer: an up to date guide
• Common skin tumours: a guide to diagnosis
• Drug treatment of nausea and vomiting related to cancer
• Malignant melanomas: diagnosis and management
• Managing the impact of a diagnosis of cancer
• Palliative care in the community
• Patients with recurrences of cancer: a guide to diagnosis and management
• Prostate cancer risk management
• Prostate cancer: diagnosis
• Screening for bowel cancer
• Screening for breast cancer
• Screening for cervical cancer
• Side effects of chemotherapy: a practical guide for primary care
• Squamous cell carcinoma
• Sun related skin conditions: diagnosis and treatment
• Suspected breast cancer: when you should refer?
• Suspected lower gastrointestinal tract cancer: when you should refer?
• Suspected lung cancer: when you should refer?
• The role of opioids in cancer pain: an up to date guide.

The Cancer Council Australia has compiled a directory of cancer resources to support GPs and other health professionals.

Developed by Cancer Council‘s General Practice Committee, the directory provides a single point of access to state, territory and national cancer resources.

Developed in collaboration with the Australasian College of Dermatology, this comprehensive dermatological course is aimed at improving the knowledge, clinical skills and experience of Medical Practitioners in diagnosing and treating patients presenting with skin cancers.

The course comprises four online study modules that can be completed at your own pace, one 2 day face to face, hands on workshop  and a 12 session clinical placement with a qualified dermatologist.

The aim of Education Program in Cancer Care (EPICC) is to improve the quality of cancer control particularly in rural and regional Australia by providing greater opportunities for interested medical practitioners to increase their expertise in cancer management.

The objectives of EPICC are:

• To enable interested medical practitioners, particularly those in regional and rural Australia who are not specialist oncologists, to acquire sufficient knowledge and skills to play a more active role in the delivery of quality, evidenced based cancer care; and
• To develop modular learning packages in oncology to increase knowledge and skills of generalist medical practitioners in the management of cancer, including training regarding safety of chemotherapy administration and management of common complications of cancer treatments.

The outcomes of EPICC are:

• Increased skills and expertise of registered medical practitioners in implementing evidence-based cancer risk reduction interventions
• Promoting and supporting patient participation in cancer screening programs
• Facilitating early diagnosis of cancer
• Providing appropriate referral and greater coordination of care
• Increased knowledge of evidence based cancer treatment options and clinical trial participation
• Increasing awareness of chemotherapy and radiotherapy toxicities and their management
• Provision of psychosocial support
• Appropriate referral and working in multidisciplinary teams
• Increased involvement of general practitioners in multidisciplinary care of cancer patients.
• Greater provision of routine cancer care in rural areas by medical practitioners to reduce the need for patient travel to metropolitan centres for care.
• Better educational opportunities for non-cancer specialist medical practitioners to improve skills in care coordination thereby increasing patient satisfaction.
• Increased opportunities for general practitioners in cancer education and multidisciplinary care provision to increase practitioner confidence in providing cancer care.
• Improved cancer care through coordination and education of medical practitioners in order to improve overall outcomes, especially in rural and remote areas of Australia.

Engaging General Practitioners (GPs) in professional development often requires creative thinking and an understanding of appropriate incentives. GPs are key stakeholders in the health system and many people demand their time. Some of the most successful incentives are ones that require minimal change to their practice and work through systems and organisations they are already familiar with. Involvement must offer something GPs see as valuable to both their professional learning, and the quality of care they can provide.

The resources in this toolkit can assist health services and educators to find a way to engage GPs in professional development and service improvement activities.

gplearning is an interactive online CPD education service. gplearning offers a multitude of activities, which covers both Group 1 and Group 2 QA&CPD points, which are released on a monthly basis across a wide range of health topics, including cancer.

gplearning features a number of approved Category 2 activities focusing on the screening and management of cancer including:

• Screening for early detection of cancer
• National Bowel Cancer Screening Program v2
• Strengthening cancer care: psychosocial support module
• Managing gynaecological malignancies in general practice
• Cervical cancer multiple choice questions
• Cancer multiple choice questions.

Activities are accredited for CPD points with RACGP and members can track their accrued points online via the website.

For more information contact the gplearning helpdesk on 1800 284 789, email contactus@gplearning.com.au

The Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practice activity aims to improve the health of Aboriginal and Torres Strait Islander peoples by enhancing the cultural awareness of general practitioners (GPs), general practice staff, primary health care staff, and other health care providers. Medical students will also benefit.

For further information and resources developed by the RACGP in this area, please see this fact sheet, the National Guide to Aboriginal Health or order RACGP's educational DVDs.

The Management of secondary lymphoedema: workshop module for health professionals aims to provide health professionals with an understanding of best practice relating to the management of secondary lymphoedema.

The module has been accredited by the Royal Australian College of General Practitioners (RACGP) as a QA & CPD Category 2 activity.

It is intended that the module be delivered by a GP and lymphoedema practitioner.

The CD-ROMs for the workshop include:

• PowerPoint presentation and presentation notes
• workshop agenda (template)
• promotional flyer (template)
• certificate of attendance (template)
• workshop evaluation form (template)
• The management of secondary lymphoedema - a guide for health professionals (MSLG)
• Lymphoedema - what you need to know (LNKC)
• Lymphoedema - Indigenous brochure (ILB)

Order:

If your organisation is interested in running a lymphoedema educational training program for health professionals or Indigenous health workers, please contact 1800 624 973 to order a copy of the relevant module.

NBOCC General Practitioner Education Series has been developed to support GPs in investigating symptoms that may be due to breast or ovarian cancer and in caring for patients with breast or ovarian cancer. The resource comprises a series of four evidence-based topic-specific workshop modules for presentation by GPs for implementation by GPs through the Divisions of General Practice:

• Module 1 - Investigating a new breast symptom
• Module 2 - Assessing symptoms that may be ovarian cancer
• Module 3 - Younger women and breast cancer
• Module 4 - Communication skills training for GPs.

Also available: The management of secondary lymphoedema workshop module for health professionals; and Secondary lymphoedema: workshop module for Indigenous health workers.

A workshop kit can also be ordered.

The General Practice Group assists the Cancer Institute NSW in achieving its objectives in cancer control and care in general practice and related matters as part of the NSW Oncology Groups (NSWOG).

NSWOG General Practice has been closely aligned with the Screening and Prevention Divisions of the Cancer Institute NSW, by providing timely and strategic expert comment on the development and implementation of key initiatives in these areas.

For information on joining the group, contact NSWOG or email: nswog@cancerinstitute.org.au

This free, peer reviewed module aims to emphasise appropriate management and referral of patients with suspected recurrences and to help clinicians diagnose and manage patients with recurrences of cancer.

The PGPPP represents an opportunity for postgraduate year (PGY) 1 to 3 doctors to gain exposure to rural and remote practice.

Providing junior doctors with experience in this specialised area of medicine, the Australian College of Rural and Remote Medicine (ACRRM) manages 140 training placements across Australia.

The placements are an average of 12 weeks duration but in some remote locations can be up to 26 weeks.

The overall aim of this program is to improve the quality and accessibility of palliative care services to all people with life-limiting conditions and their families by providing primary carers with an ideal opportunity to learn from experienced specialist staff to enhance skills, knowledge and experience in the palliative approach.

PEPA provides primary carers (nurses and allied health; GPs and rural medical staff; Aboriginal and Torres Strait Islander Health Workers; and other health professionals) with an opportunity to develop their knowledge and skills in the palliative approach to care through:

• funded clinical workforce placements or workshops
• integration of learning into your workplace
• establishing networks of support.

The PEPA learning experience helps primary carers to:

• gain a clear understanding of principles of good palliative care identify the needs of patients with life-limiting conditions
• understand the role of their discipline in managing common problems faced by palliative care patients
• recognise their own knowledge base/scope of practice in regard to optimal palliative care provision
• identify personal coping strategies for effective management of personal issues related to working in this area.

The Cancer Council Australia has developed an online module about bowel cancer and the National Bowel Cancer Screening Program that available on the Royal Australian College of General Practitioners (RACGP) gplearning website for members and non-members.

The module offers GPs the latest information and approaches to screening for major forms of cancer including breast cancer, cervical cancer, melanoma, lung cancer, ovarian cancer, prostate cancer and bowel cancer.

Activity can be completed in one or a number of sessions. The module takes two hours to complete.

Members of the college and those with a QA number with the college will receive 2 RACGP QA&CPD points for completing the module. 

Members of the RACGP can login using your username and password.

Non-members can click HERE for directions to access the module for FREE.

Radiology Online is an online resource designed for rural medical practitioners interested in obtaining radiology advice and education.

Radiology Online is moderated by Dr Tony Lamont, Chief Radiologist at the Townsville Base Hospital in Queensland.

Doctors enrolled in Radiology Online are able to submit digital x-ray images of cases and obtain personalised feedback from Dr Lamont. There are also online cases to work through, a condition index, recommended links to external sites, education resources and other discussion forums.

Radiology Online is available to all rural and remote doctors, hosted through ACRRM's Rural and Remote Medical Education Online (RRMEO) and funded by the Australian Government Department of Health and Ageing under the Medical Specialist Outreach Assistance Program (MSOAP).

The toolkit was derived from a pilot project conducted in Western Australia by Professor Moyez Jiwa and his team at the Curtin University of Technology. The pilot involved recruitment of GPs and specialists in Albany and Perth. The project used a process of review and feedback to rate the importance of a range of information in letters regarding colorectal, breast, urological, gynaecological, upper gastroenterology and respiratory cancers.

The result is a checklist of information that the group of GPs and specialists consider to be of importance in providing treatment and care. This toolkit is designed to be used by health service professionals who are able to enlist general practitioners and specialists in their area to participate. It is designed for use by relatively small groups of practitioners (up to 15 participants).

A free online learning module developed for BMJ Learning by Jane Maher and Jeanette Dickson at the Mount Vernon Cancer Centre, London.

After completing this module, participants should have a better knowledge of:

• The common acute side effects of chemotherapy
• The common late side effects of chemotherapy
• How life threatening side effects can present
• Practical ways to help overcome these side effects.

Tele-Derm is an internationally recognised online resource designed primarily for rural doctors interested in obtaining practical advice on the diagnosis and management of skin disease in general practice.

Through Tele-Derm, GPs are able to access online dermatological case studies, education opportunities, recommended links, and discussion forums where rural doctors from anywhere in Australia can electronically submit their own specific de-identified cases for assessment. Our resident Dermatologist, Dr Jim Muir, provides free advise on diagnosis and management of cases submitted to the forums.

Tele-Derm is hosted through ACRRM's Rural and Remote Medical Education Online (RRMEO) and is available to all rural and remote doctors as part of a new partnership with the Australian Government Department of Health and Ageing under the Medical Specialist Outreach Assistance Program (MSOAP).

ThinkGP (previously known as Genesis Ed online education) is a leading provider of online education solutions to GPs and other health care providers.

In collaboration with leading cancer organizations, including The Cancer Council of Australia, ThinkGP have developed several Active Learning Modules that are accredited by ACRRM and RACGP for continuing education points.

Each module includes clear learning objectives and access to relevant clinical guidelines:

Topics include:

• Cancer in General Practice. Module 1: Prevention and screening
• Cancer in General Practice. Module 2: Bowel cancer
• Cancer in General Practice. Module 3: Familial cancers and family history
• National Bowel Cancer Screening Program
• Prostate Cancer Risk Management ALM
• Prostate Cancer Risk Management - Case 1: Jack
• Prostate Cancer Risk Management - Case 2: Bill
• Prostate Cancer Risk Management - Case 3: Max
• Young Men's Health. Case 2 - Dylan

Cancer Australia has released a new resource for general practitioners and gynaecologists to assist in effective and timely investigation of symptoms which could be endometrial cancer. Endometrial cancer is the most common invasive gynaecological cancer in Australia and the incidence of the disease is increasing.

The guide will assist health professionals in assessing women with abnormal vaginal bleeding.

For further information, see the fact sheet on endometrial cancer.

From their collective experience in Australia and the USA, Anthony Dixon and Scott Hall have compiled a list of golden rules for general practitioners to help reduce errors and problems with skin cancer management. It is anticipated that these tips will provide a brief yet informative reference when faced with skin cancer management concerns in general practice.

These rules were first published in Australian Family Physician in August 2005 and were updated in 2008.

• Medicare Items: Helping You Deliver Comprehensive Cancer Care: Organised according to the National Service Improvement Framework for Cancer Services (NSIF) and Cancer Professional Development Framework priority areas, this document presents a summary of Medicare Items related to cancer care delivery.
• Final Report: Role Redesign Primary Care - Shared Care Models of Cancer Treatment and Surveillance Post Treatment
• Primary Care - Reducing Risk
• Primary Care - Finding Cancer Early
• Primary Care - Managing Cancer
• Primary Care  - Networks

CareSearch is an Australian website supporting health professionals providing palliative care and patients receiving palliative care and their families by providing evidence based materials.

The new GP pages are designed to support GPs caringfor palliative patients by addressing the clinical and practical issues associated with providing palliative care in the community.

These issues include managing symptoms, caring for a dying patient, supporting families and making it work in the general practice setting.

There is also an extensive resources list of palliative care tools, documents and agencies organised by topic that can be directly accessed by GPs.

A guide to assist general practitioners to recognise the symptoms of lymphoma and refer patients for appropriate treatment.

eviQ Cancer Treatments Online is a single repository of standardised, current, evidence based, peer reviewed information about clinical cancer treatments. Designed by medical oncologists to reduce unneccesary practice variation, eviQ provides clinicians, primary carers, patients and carers in all clinical and geographical settings with free 24 hour access to comprehensive information, relevant to the Australian context.

In scope and presentation eviQ represents a significant advance on its forerunner CI-SCaT. The eviQ information system offers standardised and comprehensive information that aligns to the clinical workflow and supports the clinician at the point of care. eviQ also provides treatment and procedure specific patient information for use by clinicians delivering care to cancer patients.

Information is targeted via categories:

• Cancer Genetics
• Haematology
• Marrow Transplantation
• Medical Oncology
• Medical Physics
• Nursing
• Palliative Care
• Patient Information
• Primary Health Care (Cancer Australia funded section)
• Radiation Oncology
• Adolescent and Young Adult (AYA)
• Bone Marrow Transplant (HPCT)

eviQ also includes a searchable database of cancer symptoms and cancer medications including information about adverse reactions, a freely accessible opioid calculator and links to many other credible sources of cancer information.

A poster describing the eviQ Primary Care project is available here.

The Minister for Indigenous Health, the Hon Warren Snowdon, launched the new GP Resource Kit on 9 December 2010 at the Aboriginal Medical Services Alliance Northern Territory.

The GP Resource Kit is a tool for doctors, health professionals and staff working in Indigenous health services and general practices to understand how to access and make the most of the new initiatives in the Indigenous Chronic Disease Package.

Also available is the Indigenous Chronic Disease Package Annual Progress Report 2009-10.

Diagnosing lymphoma is often challenging as patients may present with a varied range of clinical features. To assist GPs, this decision support tool was prepared by the Leukaemia Foundation’s Medical and Scientific Advisory Committee.

The Leukaemia Foundation has developed a tool to assist GP’s in the diagnosis of myeloma.

Myeloma (also called multiple myeloma) is the most rapidly increasing blood cancer in Australia. The diagnosis of myeloma can be challenging as it is reasonably rare with approximately 1500 people diagnosed each year in Australia. A GP may only encounter a few patients in their career and this may lead to limited awareness of the condition.

This information sheet is to assist general practitioners in managing the clinical and psychosocial aspects of care of the woman with metastatic breast cancer and her family. This guide provides evidence based recommendations relevant to general practice adapted from the Clinical practice guidelines for the management of advanced breast cancer (National Breast Cancer Centre 2001).

A chart detailing symptoms a woman with metastatic breast cancer may experience requiring urgent treatment is included.

Based on the clinical practice guidelines for melanoma developed by NHMRC, this brief guide assists general practitioners to develop diagnostic skills to recognise melanoma in the early stages, including practice points, clinical diagnosis guides and examples of visual appearances of melanoma.

These 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program and are designed to help health care institutions and clinicians provide—and consumers to receive—safe, quality health care at various points in the health care process—in the hospital, in the emergency department, in the intensive care unit, in the pharmacy, and when being discharged from one setting to another.

A variety of evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings have been developed in areas including:

• Handoffs and Transitions
• Discharge
• Medication Safety
• Medication Reconciliation
• Work Processes
• Communication and Patient Centred Care
• Infection

This site links to a range of algorithm and nomogram tools and software developed to assist in predicting the extent of prostate cancer, including those developed by John Hopkins University and Memorial Sloan Kettering Cancer Centre.

Predictive algorithms and nomograms combine multiple variables to provide information that is statistically more significant than any individual variable. A nomogram is "an objective tool that uses an algorithm or mathematical formula to predict the probability of an outcome". These tools can give probabilities of cancer location or of treatment success, based on scientific studies done with hundreds or thousands of patients. 

Algorithms/nomograms may be valuable for evaluating the potential extent of disease and risk of recurrence but they do not determine outcomes.

Reviewed in January 2010, this document provides a quick reference guide for general practitioners regarding Medicare billing for Chronic Disease Management (CDM) - Item Numbers 721-731 as per the Medicare Benefits Schedule, including:

• Preparation of a GP Management Plan (GPMP) - Item 721
• Coordination of Team Care Arrangements (TCAs)- Item 723 
• Review of a GP Management Plan - Item 725
• Coordination of a Review of Team Care Arrangements - Item 727
• Contribution to a multidisciplinary care plan being prepared by another health or care provider -Item 729
• Contribution to a multidisciplinary care plan being prepared for a resident of an aged care facility - Item 731

This summary is designed to assist general practitioners in managing aspects of follow-up care and support for women following completion of active treatment for early breast cancer.

This document supplements guideline recommendation 25 about follow-up care contained in the Clinical Practice Guideline for the Management of Early Breast Cancer, 2nd edition 2001.

Providing guidance about the diagnosis/ evaluation/ risk assessment of cancer in Family Practice in the UK, this guideline offers advice on the referral of adults and children with suspected cancer to specialist services.

Sydney Cancer Centre has the largest concentration of cancer specialists in NSW, and are nationally and internationally renowned for the treatment of melanoma, myeloma, head and neck cancer, lung cancer, colorectal cancer, sarcoma, and gynaecological cancer, and for clinical cancer research.

The website hosts a directory of cancer specialists, based mostly in Sydney, NSW, across each of the tumour streams to support GPs to make appropriate referrals. The Sydney Cancer Centre treats all cancers and provides all treatment modalities.

They have specific multidisciplinary services for the major cancer groupings, each with regular meetings for planning and monitoring patients' care plans.

The Sydney Cancer Centre is happy for general practitioners or referring specialists to participate in these meetings, in person or via videoconferencing, either when their patient is being discussed or more generally for professional development and support.

The Australian Practice Nurses Association is the peak national body supporting nurses in primary health care.

The professional development section of the website provides information regarding CPD requirements for practice nurses, information regarding available courses and links to online learning opportunties, including National Bowel Cancer Screening Program education and non-clinical skills such as understanding the MBS Items, IT and business skills. Some fees may apply for courses and to non-members completing online courses.

Coming soon is the APNA CPD portal which will allow members to securely record, store and print their CPD points and information.

Membership is available to both individual and groups of practice nurses.

Funded by Australian Government Department of Health and Ageing, this competency toolkit provide a useful framework that reflects nursing practice in the general practice setting for both registered and enrolled nurses and reflect the new ANMC competency standards for registered nurses. Included on the website are: 

• Tool-kit introduction 
• Competency standards for nurses 
• Competency standards for RNs 
• Competency standards for ENs 
• Using the standards for employment purposes 
• Role statement for RNs 
• Role statement for ENs 
• Performance management tool for RNs 
• Performance management tool for ENs 
• Scope of nursing practice
• Professional supervision of ENs
• Glossary

AAPM is a non-profit, national association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession.

The website provides links, resources and information for members to assist them in their practice, in areas including:

• Financial and legal
• IT
• Government
• Human Resources
• Medical Services 
• Careers

AAPM holds regular professional development, member events and conferences, including the Annual GP Conference, held in combination with the Royal Australian College of General Practitioners.

A range of membership categories are available.

Developed in consultation with some of Australia‘s leading clinicians and health care managers, this module aims to address some of the workplace issues and sources of conflict that may impact upon the professional relationship between clinicians and health care managers.

Over three sections, Exploring the Divide, Identifying Common Ground, and Working Together toward Change, the module provides information, first-hand advice, case studies, practical skills and other activities to assist clinicians and managers to understand the others perspective to enhance their relationship in order to better support each other in the shared goal of providing optimal patient care.

General Practice – A Safe Place focuses on the prevention and management of patient initiated threats to the personal safety of general practice staff.

The

booklet outlines a range of practical strategies to assist general practices to appropriately minimise risks of violence, including means to:

• create a safe physical environment
• flag the files of patients with a history of violent behaviour within a practice
• assertively clinically manage patients at risk of violent behaviour
• work with other services to reduce the future risk of violence, and
• support the general practice team after experiences of violence.

A suite of eight small group learning modules designed to aid professional development and help general practitioners and their staff to prevent, detect and manage cancer in their practices.

Modules use case studies, reflective practice activities, journal articles and evidence-based guidelines to stimulate discussion and encourage knowledge sharing. Each module is free of charge and takes about 1 to 2 hours.

The Cancer Council Victoria recommends that groups complete Modules 1 and 2 as an introduction. All modules can also be undertaken as stand-alone education activities.

Modules cover the following topics:

• Module 1 - What can general practice do about cancer?
• Module 2 - Prevention and screening
• Module 3 - Familial cancers and family history
• Module 4 - Bowel cancer
• Module 5 - Prostate cancer
• Module 6 - Cervical cancer
• Module 7 - A whole-of-practice approach to cancer care
• Module 8 - Understanding and using cancer services workshops.

In addition to the small group learning activities, The Cancer Council Victoria runs a series of workshops for general practice.

Topics include:

• Family bowel cancer
• Family breast cancer
• Can you spot the difference? (early detection of melanoma)
• National bowel cancer screening program
• Smoking cessation in general practice
• Educating patients about breast health (for practice nurses)

A variety of tools and resources have been developed overseas and in Australia to assist health services and health professionals in successfully managing change and implementing service improvement strategies. This section of Cancer Learning provides a brief overview of key steps to be considered as well as links to national and international tools and information sources. Some sites provide case studies with information about benefits, barriers and enablers.

Designed in collaboration with Australian Practice Nurse Association (APNA), the Australian Association of Practice Managers (AAPM) amd Department of Health and Ageing, MyPracticeTeam is a free, downloadable computer application providing quality clinical information, resources, research, services and links to many relevant websites for practice nurses, practice managers and practice staff, as it has recently become increasingly clear that participation by all members of the practice team, including nurses and managers, can be of great benefit in providing the highest quality of care to the community.

Involvement of these staff can assist GPs in fulfilling their educational requirements as well as improve patient outcomes. Therefore, the RACGP has developed resources that can be either downloaded from the site http://www.mygeneralpractice.org.au/practiceresources that can structure and guide various educational and quality improvement activities for all practice team members to further enhance and expand the services provided to patients by the practice.

Templates can also be accessed from the site to be used to conduct risk assessments to identify where improvements need to occur in order to enhance the quality and safety of care provided by the practice.

Working in a general practice is a different and often unfamiliar environment to other areas of nursing practice. The role for the practice nurse is a wide ranging generalist role, requiring comprehensive skills and knowledge. It is therefore important for the delivery of safe practice and the retention of nurses in general practice that they are supported with a formal orientation and induction program.

AGPN has developed this program, Orientation Program for Nurses New to General Practice, consisting of 4 modules, to meet this need. 

The modules have been approved for RCNA and APNA CPD points.

The quality framework is a tool that can be implemented within a practice to facilitate the systematic analysis of the general practice environment in terms of the quality of care - current status and activities for enhancement, barriers to achievement, and initiatives for future improvement.

Several supporting documents are also available to assist in the implementation of the framework and the evaluation of the practice, including:

• A Quality Framework for Australian General Practice background paper (520Kb)
• A Quality Framework for Australian General Practice companion guide (295Kb)
• Gap Analysis (213Kb)
• Quality Framework Diagram (85Kb)
• Dimensions of Quality (75Kb)

Free, online training is available for medical practice staff to advance their computer and professional skills.Courses are available in medical terminology, effective communication and Microsoft Office (PowerPoint, Excel and Word).