Oxford Handbook of General Practice (4 edn)
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What is general practice?
‘Generalism describes a philosophy of practice which is person, not disease, centred; continuous, not episodic; integrates biotechnical and biographical perspectives; and views health as a resource for living and not an end in itself.’1
In the early 19th century, when apothecaries, physicians, and surgeons provided medical care, the term ‘general practitioner’ became applied to apothecaries taking the Membership Examination of the Royal College of Surgeons of England.
Over the past 60y, general practice has established itself as the cornerstone of most national healthcare systems. In so doing, general practitioners (GPs or family physicians) have shown the intellectual framework within which they operate is different from, complementary to, but no less demanding than that of specialists.
What is medical generalism?
The RCGP defines medical generalism as: ‘An approach to the delivery of healthcare that routinely applies a broad and holistic perspective to the patient’s problems.’ It involves:
Seeing the person as a whole and in the context of his/her family and wider social environment
Using this perspective as part of the clinical method and therapeutic approach to all clinical encounters
Being able to deal with undifferentiated illness and the widest range of patients and conditions
In the context of general practice, taking continuity of responsibility for people’s care across many disease episodes and over time
Also in general practice, coordinating care as needed across organizations within and between health and social care
The role of the GP
In the UK, >90% of the population is registered with a GP. GPs diagnose illness, treat minor illness within the community, promote better health, prevent disease, certify disease, monitor chronic disease, and refer patients requiring specialist services. General practice is the primary point of access to healthcare services.
Although patients have an average of 5.5 consultations with their GP every year in the UK, only 1 in 20 consultations results in a secondary care referral. Everything else is dealt with in the primary care setting. To do this, GPs must:
Have a working knowledge of the whole breadth of medicine
Maintain ongoing relationships with their patients—they are the only doctors to remain with their patients through sickness and health
Focus on patients’ response to illness rather than the illness itself, taking into account personality, family patterns, and the effect of these on the presentation of symptoms
Be interested in the ecology of health and illness within communities and in the cultural determinants of health beliefs, and
Be able to draw on a far wider range of resources than are taught in medical school, including intuition, knowledge of medicine, communication skills, business skills, and humanity
In addition to day-to-day medical care of their patients, GPs in the UK have a number of additional roles:
Gatekeeping GPs control access to hospital-based services, enabling cost-effective care
Navigating GPs work with patients/carers to guide them effectively and safely through the healthcare system
Service redesign and improvement GPs manage service provision within their own practices, and beyond their practice boundaries
Research GPs need critical appraisal skills to understand and apply relevant evidence to inform clinical decision making. They need to be competent in collecting and analysing data for service improvement, and must collaborate effectively in primary care-based research
Education GPs can be effective teachers in a wide range of contexts, educating patients, practice staff, medical students and junior doctors, fellow GPs, and the general public
Leadership Many GPs have leadership roles—in their own practices, within their localities, or nationally
What is the difference between GPs and specialists?
Marshall Marinker contrasted the role of generalists and specialists as shown in Table 1.1
| GPs | Specialists |
|---|---|
Exclude the presence of serious disease | Confirm the presence of serious disease |
Tolerate uncertainty—managing patients with undifferentiated symptoms | Reduce uncertainty—investigating until a diagnosis is reached |
Explore probability seeing patients from a population with a relatively low incidence of serious disease | Explore possibility seeing a preselected population of patients with a relatively high incidence of serious disease |
Marginalize danger—recognizing and acting on danger signs even when diagnosis is not certain | Marginalize error—ensuring accurate diagnosis and treatment |
| GPs | Specialists |
|---|---|
Exclude the presence of serious disease | Confirm the presence of serious disease |
Tolerate uncertainty—managing patients with undifferentiated symptoms | Reduce uncertainty—investigating until a diagnosis is reached |
Explore probability seeing patients from a population with a relatively low incidence of serious disease | Explore possibility seeing a preselected population of patients with a relatively high incidence of serious disease |
Marginalize danger—recognizing and acting on danger signs even when diagnosis is not certain | Marginalize error—ensuring accurate diagnosis and treatment |
To perform their roles well, GPs must show empathy for their patients; engagement and commitment to involve themselves in every aspect of patient care; appreciation of the limits of their skills and expertise; and professionalism in their dealings with both patients and colleagues.
Further information
Independent Commission on Generalism Guiding patients through complexity: modern medical generalism (2011) 
www.rcgp.org.uk
RCGP Medical Generalism: Why expertise in whole person medicine matters (2012) www.rcgp.org.uk
Simon C (
Marinker M (
General practice in the UK
Today, along with opticians, dentists, and pharmacists, GPs form the ‘front line’ of the NHS in the UK, providing primary medical care and acting as ‘gatekeepers’ to the secondary care system.
Workload
~97% of the British population are registered with a GP. Patients register with a practice of their choice in their area—whole families are often registered with the same practice. Once registered, patients stay with that practice for an average of 12y. GPs carry out ~300 million consultations/y in England alone—82% at the surgery and 4% at the patient’s home. 70% of the GP’s total workload is spent with a patient, while >20% is currently spent on administration.
Working hours
Standard working hours are 8 a.m. to 6.30 p.m. on normal working weekdays for GMS and most PMS practices although this is currently under review with a proposed change to 8 a.m.–8 p.m. cover 7 days a week. Practices may provide ‘extended hours’ as a DES (
p. 21); to qualify, the practice must provide 30min of additional opening time/1,000 registered patients at times agreed with the PCO according to local needs. Some practices also provide OOH care ( p. 21). How workload is distributed between individual doctors and PHCT staff is a matter for each practice to decide.
Primary care provider
Term used to designate any organization providing NHS primary care services.
Primary care contracts
The provider contract with the local PCO defines services primary care providers will provide, standards to achieve and payments they will receive. Currently, there are 4 contract types:
Primary care performer list
List of all doctors deemed competent to provide primary medical care held by the PCO.
Partnership
Group of self-employed contractors working together for mutual benefit. A partnership can become a primary care provider as long as ≥1 partner is a GP. Although traditionally partnerships are made up of GPs only, practice managers, nurses, allied health professionals, and pharmacists can be included within partnerships.
Independent contractor status
Around half of all GPs in the UK work as independent contractors, providing core primary healthcare services and additional services as negotiated within their contract. As such, these GPs are self-employed, running small businesses or practices. They have management responsibilities for staff, premises, and equipment. Since most GPs receive a profit share, the amount each GP is paid depends not only on income to the practice, but also expenditure:
Income
Private work Includes: private appointments (e.g. clinical assistant, industrial appointments); insurance examinations/reports; private medical examinations and certificates (e.g. HGV licence applications)
Income from the NHS GMS, PMS, or APMS contract work
Expenditure
Running costs of the practice Staff salaries; premises (rent, rates, repairs, maintenance, insurance); service costs (heating, water, electricity, gas and telephone bills, stationery and postage); training costs, etc.
Capital expenses Purchase of new medical and office equipment
Salaried GP
A GP employed by a PCO, practice, or alternative provider of medical services (APMS). PCOs and GMS practices are bound by a nationally agreed model contract, with a salary within a range set by the Review Body. PMS practices can make their own arrangements. Salaried posts have advantages for those who do not want to commit to long-term working within one practice or become involved with managerial tasks. Pay tends to be less than that of independent contractors.
GP retainer
Provides an opportunity for doctors with other commitments to maintain medical skills before returning to full- or part-time employment at a later date (usually within 5y). Practices approved for the retainer scheme must provide adequate education, supervision, and support. Members of the scheme must:
Have ‘licence to practise’ ( p. 69) and maintain their GMC registration
Work ≥12, but ≤208 paid service sessions a year (one session = 3.5h); most work 2–4 sessions/wk
Do ≥28h of educational sessions/y and take a professional journal
Freelance GP or locum
Works for practices or PCOs by a regular or intermittent arrangement or by providing medical cover on a one-off basis. Tends to be self-employed and charge on a sessional basis. Long-term locums should make their own pension provision or apply to join the NHS scheme. Some freelance GPs work from ‘locum chambers’ with administrative support to help with bookings and payments.
GP with special interest (GPwSI)
p. 70
GP registrar
GP in 3rd/4th year of specialty training p. 64
Practice boundaries
Practices set geographical boundaries around their practices agreed with their PCOs. Currently, practices only accept new patients onto the practice list who live within that boundary. In England, practice boundaries for patient registrations will be abolished after October 2014. However GPs will not be required to do home visits for patients living outside their practice boundaries; these will become the responsibility of NHS England Local Area Teams.
Practice lists
All patients registered with a particular primary care provider. Lists may be open (accepting new patients) or, by agreement with the PCO for a set period of time, closed to new patients p. 46.
Polyclinics
Also referred to as ‘Darzi centres’ are found in urban centres throughout the UK. They may be owned and run by the NHS, large GP practices, private companies, or Foundation Trusts. Key features:
Large premises serving up to 50,000 patients and housing up to 25 GPs
GP services alongside other health services, e.g. dentists, pharmacists
Extended services—consultant outpatient appointments, physiotherapy, routine diagnostic services, e.g. ECG, X-ray
Extended opening—urgent care 18–24h/d and routine GP appointments in the evenings and at weekends
Good medical practice for GPs
Make the care of your patient your first concern
Protect and promote the health of patients and the public
Provide a good standard of practice and care
Keep your professional knowledge and skills up to date
Recognize and work within the limits of your competence
Work with colleagues in the ways that best serve patients’ interests
Treat patients as individuals and respect their dignity
Treat patients politely and considerately
Respect patients’ right to confidentiality
Work in partnership with patients
Listen to patients and respond to their concerns and preferences
Give patients the information they want or need in a way they can understand
Respect patients’ right to reach decisions with you about their treatment and care
Support patients in caring for themselves to improve and maintain their health
Be honest and open and act with integrity
Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
Never discriminate unfairly against patients or colleagues
Never abuse your patients’ trust in you or the public’s trust in the profession
You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.
Good medical practice for GPs2
Good clinical care Provide best possible clinical care for patients
Maintaining good medical practice Monitor, review, and continuously strive to improve performance of yourself and your practice
Teaching and training, appraising and assessing p. 60
Relationships with patients Communicate with and listen to views and opinions of your patients; use terms/information they can understand; respect their privacy and dignity at all times
Working with colleagues Ensure effective communication channels within/outside the practice; ensure an environment for personal/professional development for everyone working within the practice
Probity Behave in a proper fashion, ensuring honesty and openness in all matters. Avoid conflicts between personal and professional roles. Research p. 82
Health GPs must be able to perform their roles to an adequate standard and be safe to practise. Concerns about performance p. 69
Continuity of care
A patient seeing the same healthcare worker over time. In the UK, this has been the norm, but continuity of care is becoming less available.
Reasons for continuity of care
A practitioner’s sense of responsibility toward his/her patients ↑ with duration of relationship and number of contacts. Continuity builds trust, creates a context for healing, and ↑ practitioner’s and patient’s knowledge of each other. Evidence:
↑ patient and doctor satisfaction
↑ compliance
↑ uptake of preventive care, and
Better use of resources (time spent in the consultation, discriminatory use of laboratory tests, and admission to hospitals)
Patients’ desire for personal care depends on the reason for the encounter. Most find it important to see their own GP for serious medical conditions and emotional problems.
Reasons why continuity of care is becoming less available
Problems balancing accessibility, flexibility, and continuity of care:
Doctor factors Flexible careers, special interests, and managerial responsibilities all limit the availability of GPs to their patients
Patient factors 24h society, in which patients want to be seen at their convenience rather than when their GP is available, makes it impossible to maintain continuous care. For minor problems and emergencies, patients do not mind who they see—as long as they see someone who can deal with their problem quickly
System factors Changing roles—nurse practitioners and other healthcare professionals commonly take on tasks which used to be done by GPs; clinical governance structures mean that patients with particular conditions are managed in clinics specifically for those conditions within the practice; other primary healthcare providers, e.g. NHS 111, walk-in clinics, and separate out-of-hours cover arrangements, further fragment care
Rationing
A full discussion on rationing healthcare is beyond the scope of this handbook, but, with continued innovation, rising demand, and limited resources, it will become an increasingly important factor in medicine worldwide. To some extent, there is already rationing by default—medicines and certain treatments are not provided on the NHS or have very long waiting lists. Government bodies, such as NICE, evaluate services and develop guidelines for healthcare professionals about medicines and services which are both clinically and cost-effective. Inevitably, this will mean that some groups will feel they are being deprived of the treatment they require. It will remain a contentious issue.
Further information
Appraisal and revalidation p. 68
GPC/RCGP Good medical practice for GPs (2008) www.rcgp.org.uk
GMC Duties of a doctor www.gmc-uk.org
Stress in general practice
Increasing stress is a feature of society as a whole. GPs score twice the national average on stress test scores. Similar figures are seen if anxiety scores are used, and 1 in 4 GPs are classed as suffering from depression if depression screening tools are used. Burnout describes the syndrome of emotional exhaustion, depersonalization, low productivity, and feelings of low achievement. Studies of British GPs consistently find significant numbers of GPs in all age groups are affected.
Causes of stress in general practice
Insecurity about work (particularly changes in NHS structure and complaints), isolation, poor relationships with other doctors, disillusionment with the role of GPs, changing demands, work–home interface, demands of the job (particularly time pressure, problem patients, and emergencies during surgery hours), patients’ expectations, and practice administration.
Roots of stress
Many of the main stressors for GPs appear to be created or perpetuated by doctors’ own policies: overbooking patients, starting surgeries late, accepting commitments too soon after surgeries are due to finish, making insufficient allowances for extra emergency patients, and allowing inappropriate telephone or other interruptions. Higher than average pressure scores occur in doctors with fast consultation rates compared to those with slower rates.
General characteristics of a stressed person at work are
Lack of concentration, poor timekeeping, poor productivity, difficulty in comprehending new procedures, lack of cooperation, irritability, aggression, withdrawal behaviour, resentment, ↑ tendency to make mistakes, and resistance to change.
Effects of stress
Effects on clinical work One study showed frustrated doctors are more willing to take undesirable short cuts in treating patients; another that those doctors with negative feelings of tension, lack of time, and frustration have poor clinical performance (measured by an ↑ prescription rate and lack of explanation to patients)
Effects on practices Stress has effects on the practice too, resulting in mistakes, arguments or angry outbursts, poor relationships with patients and staff, increased staff sickness and turnover, and accidents
Effects at home Stressed GPs may develop problems in their relationships with their partners and family at home, becoming uncommunicative at home or work, and more withdrawn and isolated
Experience of stress does not necessarily result in damage. The extent of stress necessary to ↓ performance or satisfaction levels will depend on the doctor’s personality, biographical factors, and coping methods, but a concurrent illness or coexisting life event may have additive effects and can ↑ vulnerability to stress or ↓ ability to cope.
Alcohol
Doctors commonly use alcohol as a coping method for stress. The BMA estimates 7% of doctors are addicted to alcohol and/or other chemical substances, with half of those addicted to alcohol alone.
Interventions and solutions
Improve your working conditions, e.g. longer booking intervals for patient consultations; develop a specialist clinical or academic interest within or outside the practice; learn to decline extra commitments. GPs with high stress levels do not necessarily have low morale, but there is a close correlation between levels of job satisfaction and morale—job satisfaction seems to protect against stress
Look at your own behaviour and attitudes Stop being a perfectionist; resist the desire to control everything; don’t judge your mistakes too harshly
Look after your own health and fitness Set aside time for rest and relaxation; make time for regular meals and exercise
Allow time for yourself and your family Do not allow work to invade family time. Consider changes in working arrangements to allow more time for leisure and family
Don’t be too proud to ask for help As well as formal channels for seeking help, there are several informal doctor self-help organizations and counselling services (see Useful contacts)
Chronic stress
p. 1002
Useful contacts
Occupational Health Services Available to GPs whose health is causing a performance concern.
BMA Doctors for Doctors Service and BMA Counselling Service. Provides members and their families (normally resident with them) with help, counselling, and personal support. Also produces a ‘doctors’ health and well-being’ webpage 
0845 9 200 169 www.bma.org.uk
British Doctors and Dentists Group Support group of recovering medical and dental drug and alcohol users. Students are also welcomed. Gives confidential help and advice through a local recovering doctor or dentist. 0779 2819 966
Cameron Fund Provides help and support solely to GPs and their dependants. It can meet needs that vary from those of the elderly in nursing homes to young, chronically sick doctors and their families, and those suffering from relationship breakdown or financial difficulties following the actions of professional regulatory bodies. 020 7388 0796
Sick Doctors Trust A confidential intervention and advisory service for alcohol- and drug-addicted doctors, run by doctors for doctors. 24h Helpline: 0370 444 5163 www.sick-doctors-trust.co.uk
Doctors’ Support Network (DSN) Aims to raise awareness of mental health concerns, encourage, doctors to look after their mental health and to seek help early. Confidential, anonymous support service, allowing doctors to talk about issues affecting them, whether mental health, work problems, or anything else 0844 395 3010
Royal Medical Benevolent Fund Provides specialist information and advice, and necessary financial assistance due to age, ill health, disability, or bereavement. 020 8540 9194
General practice within the wider NHS
In 1948, the National Health Service (NHS) was formed, giving free healthcare for the entire population of the UK paid for by the taxpayer. The NHS is now the largest organization in Europe. The structure of the NHS varies from country to country within the UK.
England
(See Figure 1.1)
Secretary of State for Health Head of the NHS responsible to Parliament
Department of Health (DH) Sets overall health policy in England, is headquarters for the NHS, and is responsible for developing and putting policy into practice
Monitor Independent regulator of healthcare in England
NHS Commissioning Board Key link between the DH and NHS. Advises Clinical Commissioning Groups (CCGs) and holds them to account. Manages the budget allocated to the NHS, distributing it to CCGs, and also directly commissions primary care and national services
Healthwatch England Part of the Care Quality Commission. Provides feedback from service users through a network of Local Healthwatch organizations to the Secretary of State for Health, NHS Commissioning Board, Monitor, and local authorities
Clinical Commissioning Groups (CCGs) Cornerstone of the NHS—responsible at a local level for planning, providing, and commissioning health services from service providers, and improving the health/well-being of the local population
Health and Wellbeing Boards Work with patients, CCGs, and local authorities to develop a Joint Strategic Needs Assessment (JSNA) in order to improve health/well-being of the local population. The JSNA then influences commissioning decisions across health, public, health and social care, thus promoting integrated health/social care
NHS Trusts Provide hospital and specialist community services
Structure of the NHS in England
Northern Ireland
The Department of Health, Social Services and Public Safety (DHSSPS) is responsible for:
Health and Social Care Board Agent of the DHSSPS in planning, commissioning and purchasing services for the residents of Northern Ireland, including primary care services
6 Health and Social Care Trusts Cover the whole of Northern Ireland (Belfast, Northern, Southern, Western, South Eastern, and Northern Ireland Ambulance Service) and directly provide services to people in their areas
19 Health Agencies Provide national services, e.g. Public Health Agency; Blood Transfusion; Northern Ireland Cancer Screening
Patient and Client Council Provides patient/client feedback to shape services
Further information
Scotland
Scottish Government Health Directorate Responsible both for NHS Scotland and for the development and implementation of health and community care policy
NHS Boards Health services are delivered through 14 regional NHS Boards. These Boards provide strategic leadership and performance management for the entire local NHS system in their areas and ensure that services are delivered effectively and efficiently. NHS Boards are responsible for the provision and management of the whole range of health services in an area, including hospitals and general practice
Special Boards and Public Health Body Scotland has seven Special Boards delivering services across the whole of Scotland e.g. Scottish Ambulance Service; NHS24. In addition, there is one Public Health Body
Further information
Wales
The NHS is Wales’ largest employer (7% workforce).
National Advisory Board Responsible for providing independent advice to the Welsh Minister for Health and Social Services
National Delivery Group The Chief Executive, NHS Wales, is responsible for providing the Welsh Minister for Health and Social Services with policy advice and for exercising strategic leadership and management of the NHS. To support this role, the Chief Executive chairs a National Delivery Group, forming part of the Department for Health and Social Services (DHSS). This group is responsible for overseeing the development and delivery of NHS services across Wales
Local Health Boards (LHBs) 7 boards secure/deliver healthcare services in their areas. LHBs are responsible for commissioning GP services from practices, and community and secondary care services
NHS Trusts 3 Trusts deliver services that operate throughout Wales. These are: Public Health Wales, Welsh Ambulance Services NHS Trust, Velindre NHS Trust offering cancer care services, and the Welsh Blood Service
Community Health Councils 7 statutory lay bodies (one for each LHB) that represent the interests of the public
Further information
Organizations important to general practice
British Medical Association (BMA)
Voluntary professional association and independent trade union of doctors. >80% of UK doctors are members. Also runs a publishing house, producing books and journals (including the BMJ); negotiates doctors’ pay and terms of service; provides advice about matters related to work practice; provides educational and research facilities, accommodation, dining facilities, and financial services. The General Practitioners Committee (GPC) is a subgroup.
Further information
020 7387 4499 www.bma.org.uk
Care Quality Commission (CQC)
A independent public body. Its functions are to:
Assess management, provision and quality of health and social care in England (including GP practices)
Regulate the independent healthcare sector through registration, annual inspection, monitoring complaints, and enforcement
Publish information about the state of health and social care
Consider complaints about NHS organizations that the organizations themselves have not resolved
Coordinate reviews and assessments of health and social care and carry out investigations of serious failures in the provision of care
Further information
General Medical Council (GMC)
Licenses doctors to practise medicine in the UK. It investigates complaints against doctors and has the authority to revoke a doctor’s licence, if appropriate. It also monitors standards of undergraduate, postgraduate, and continuing medical education and provides information about good medical practice.
Further information
General Practitioners Committee (GPC)
BMA committee with authority to deal with all matters affecting NHS GPs, representing all doctors in general practice, whether or not they are a member of the BMA. The committee is recognized as the sole negotiating body for general practice by the DH.
Further information
Independent Complaints Advocacy Service (ICAS)
Supports patients and their carers wishing to pursue a complaint about their NHS treatment or care.
Local Medical Committee (LMC)
Committee of GPs representative of GPs in their area. All GPs (including locums and salaried doctors) are represented by LMCs. Functions:
Statutory Consultation regarding administration of the GMS and PMS contracts; involvement with disciplinary and professional conduct committees; representation of GPs as a whole
Non-statutory Advice on all matters concerning GPs; communication between GPs; links with other bodies; helping individual GPs
National Association of Sessional GPs (NASGP)
Acts as a voice and resource for all NHS GPs who work independently of the traditional ‘GP principal’ model. This includes GP locums, retainers, salaried GPs, and GP assistants.
Further information
National Institute for Health and Care Excellence (NICE)
Special authority which aims to provide patients, health and social care professionals, and the public with authoritative guidance on ‘best practice’ and thus improve the quality/consistency of health and social care services. It evaluates health technologies and reviews management of specific conditions.
Further information
NHS Business Services Authority (NHSBSA)
p. 141
Patient Advice and Liaison Service (PALS)
Provided by all healthcare organizations running hospitals, GP or community health services. Equivalent service in Scotland is the Patient Advice and Support Service (PASS). Aims to:
Advise and support patients, their families, and carers
Provide information on NHS services
Listen to and record concerns, suggestions, or queries. PALS can liaise directly with NHS staff and managers regarding patients’ concerns
Help to sort out problems quickly
Direct NHS users to sources of independent advice and support, e.g. Independent Complaints Advocacy Services (ICAS)
Royal College of General Practitioners (RCGP)
Founded to ‘encourage, foster and maintain high standards within general practice and to act as the voice of GPs on issues concerned with education, training, research and standards’. Services include:
Publishing—books and journals including British Journal of General Practice and InnovAiT
Education—online learning, courses, conferences
Revalidation support, including e-portfolio
Representation of GPs at national and international levels
International collaboration, including international membership section
Support for specific groups, e.g. First5 (for GPs within 5y of their Certificate of Completion of Training); AiT Committee for GPs in training
Statutory responsibilities include:
Developing and updating the GP training curriculum
Setting and managing the UK licensing examination for general practice
Managing certification and recertification
3 grades of membership:
Members are entitled to speak and vote at meetings, and to use the designation MRCGP ( p. 66)
Fellows Highest grade of membership; holders use the designation FRCGP ( p. 66)
Associates For doctors still in training. Associates can participate in College activities but cannot vote or use the designation MRCGP
Further information
Practice in other countries
It is beyond the scope of this book to discuss different systems of healthcare and practice regulations outside the UK; however, in most countries, there is a registration body (usually termed the ‘Medical Council’) which ensures doctors are qualified and fit to practise; an organization representing the interests of the medical profession generally (often termed the ‘Medical Association’); and separate specialist bodies representing the interests of family practitioners. Details can be obtained from the following websites:
International Directory of Medical Regulatory Authorities
Lists worldwide medical regulatory bodies and contact details. www.iamra.com
World Organization of Family Doctors (WONCA)
Includes a list of member organizations and contact details.
European Union of General Practitioners/Family Physicians
Gives overview of different healthcare systems in member states and contacts for member organizations. www.uemo.eu
Medical Association of South East Asian Nations (MASEAN)
Contains contact details for Medical Associations in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar (Burma), Philippines, Singapore, Thailand, and Vietnam. www.masean.org
Country-specific information
Australia
Australian Medical Council www.amc.org.au
Australian Medical Association www.ama.com.au
Royal Australian College of General Practitioners www.racgp.org.au
Canada
Medical Council of Canada www.mcc.ca
Canadian Medical Association www.cma.ca
College of Family Physicians of Canada www.cfpc.ca
China
Chinese Medical Association www.cma.org.cn
Hong Kong
Medical Council of Hong Kong www.mchk.org.hk
Hong Kong Medical Association www.hkma.org
Hong Kong College of Family Physicians www.hkcfp.org.hk
India
Medical Council of India mciindia.org
Indian Medical Association www.ima-india.org
Ireland (Eire)
Irish Medical Council www.medicalcouncil.ie
Irish Medical Organization www.health.ie
The Irish College of General Practitioners www.icgp.ie
Japan
Japan Medical Association www.med.or.jp
Japan Primary Care Association www.primary-care.or.jp
New Zealand
Medical Council of New Zealand www.mcnz.org.nz
New Zealand Medical Association www.nzma.org.nz
Royal New Zealand College of General Practitioners www.rnzcgp.org.nz
Pakistan
Pakistan Medical and Dental Council www.pmdc.org.pk
Singapore
Singapore Medical Council www.smc.gov.sg
Singapore Medical Association www.sma.org.sg
College of Family Physicians Singapore www.cfps.org.sg
South Africa
Health Professions Council of South Africa www.hpcsa.co.za
South African Medical Association www.samedical.org
South African College of Family Physicians www.collegemedsa.ac.za
USA
Educational Commission for Foreign Medical Graduates (ECFMG) www.ecfmg.org
American Medical Association (AMA) www.ama-assn.org
Federation of State Medical Boards www.fsmb.org
American Board of Family Practice www.abfp.org
American Academy of Family Physicians www.aafp.org
