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Genetic Health Care - GP curriculum

Discussion Paper on competency mapping.

Introduction

In developing the capacity and capability for providing genetic-based health care in primary care, one way forward is to build on routine procedures and core skills already in existence in the general practice.

This paper sets out core roles for GPs in primary care and a map of what roles and competencies might be required to develop genetic health care in the community, together with the development and implementation support needed.

Core GP roles include:

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generalist and holistic, comprehensive and continuing medical care

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identifying illness

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gate-keeping

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co-ordinating long-term care for complex conditions

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dealing with undifferentiated problems

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providing continuing care

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prevention

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dealing with families and with psycho-social problems

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enabling patient choice

All of these could be further developed to meet the needs of patients with genetic disease or anxieties about familial predispositions.

Relevant GP skills

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recognising disease and its absence,

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dealing with inchoate presentation

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family history taking

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undertaking appropriate investigations

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managing uncertainty

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clinical management of complex conditions including therapeutics

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continuing clinical supervision

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running screening programmes

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preventative care

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explaining risk

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shared decision-making and other communication skills.

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appropriate referral

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co-ordination of care

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multidisciplinary working

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managing the psycho-social aspects of illness

Introducing genetics: Building on the core skills of primary health care

Role

Tasks
core GP tasks*

Skills/knowledge
core GP skills†

Support needed

Identifying genetic condition and individual/family risk

·             Recognising disease*

·          Appropriate investigation*

·        Key pathological features and natural history of common conditions

·    Patterns of inheritance

·        Family history taking†

·   Information on genetic conditions

·   Responsive specialist services

Gate- keeping

·          Recognising disease*

·          Assessing risk

·          Requesting appointment*

·        Seriousness of condition

·        Availability of secondary services

·        Recognising own competence limits†

·        shared decision-making†

·   Risk assessment tools/decision support

·   Referral guidelines

·    

Prevention

·             Assessing risk to patient or offspring

·          preconception or antenatal counselling and testing

·          Life style and other preventive advice*

·        Knowledge of risks

·        Managing uncertainty†

·       Family history taking†

·        Using FH information

·        Absolute/relative risk†

·        Discussing risk†

·        Promoting behaviour change†

·        Shared decision-making†

·        Ethical awareness and decision-making skills†

·        Team working†

·   Educational material and professional development

·   Family history recording templates

·   Risk assessment tools/decision support

·   Access to tests and follow-up services

·   Raised public awareness

Continuing Care

Including psycho-social support

·          Counsel re prognosis*

·    Manage emerging manifestation*

·          Advise on family issues*

·          provide psycho-social support*

·        Counselling and listening skills

·        Local community and family knowledge†

·        How to access information about rare conditions

·        Availability of clinical networks†

·   Counselling skills training

·   Information on pathology and natural history

·   Information on secondary services

·   Responsive secondary services

·   Access to skilled genetic counselling

Screening and testing

·             Identify people at risk*

·             Operate call programme*

·             Carry out test or refer for it*

·             Pre and post test counselling*

·        Managerial and organisational†

·        Skills in performing test

·        Knowledge of tests , implications, ethical issues

·        Counselling skills

·   Centralised support for call: register, invitation letter

·   Information about tests

·   Access to tests

Patient education

·          Providing general education to practice population on inheritance and disease

·        Information transfer skills†

·        Counselling skills

·   Information about common conditions

·   Patient friendly information format

·   Time in consultation

GPs with a Special Interest in Genetics

Useful documents

Our Inheritance, Our Future – Realising the potential of genetics in the NHS June 2003 Cm 5791 priced document £17 available from The Stationery Office or on the internet at  www.doh.gov.uk/genetics/whitepaper.htm

National Strategy for Education in Genetics for Health Professionals  1st stage review of current provision published:  Education in Genetics for Health Professionals – Report to the Wellcome Trust  Hilary Burton  Public Health Genetics Unit (PHGU), July 2002 available on project website at  www.phgu.org.uk/about_phgu/education.html.

 Addressing Genetics, Delivering Health  Hilary Burton published 30 September 2003. available on project website at  www.phgu.org.uk

Review of training and proposals for arrangements for a national training programme for haemoglobinopathies  Pippa Murray et al.  report for NSC
Contact for further information Kay Chamberlain at the National Screening Programme e-mail kay.chamberlain@institute-of-health-sciences.oxford.ac.uk

My very own medicine - What must I know  David Melzer et al  published by PHGU  October 2003
also available on the phgu website www.phgu.org.uk/about_phgu/pharmacogenetics.asp

Cancer Genetics: The Kenilworth Model  report of an expert working group.
Available  on the  Macmillan website at www.macmillan.org

Alison Fry et el

GPs' views on their role in cancer genetics services and current practice

1999

Family Practice pp468

69

Cancer, family practice, genetics, primary health care

  

North West England Faculty

Genetics in Primary Care

1998

Occasional Paper 77 The Royal College of General Practitioners

56

Training in primary care, genetic counselling, continuing care, team working, ethics, family involvement, clinical skills.

 

 Source: Alison Hill

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The RCGP - Clinical and Special Projects Network, Virtual Genetics Group home page.

 

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