What is a general practitioner in a clinic? All Moscow clinics are equipped with general practitioner offices

Global health care reform aims to improve overall service efficiency and ensure greater value for money in the delivery of services. Within the framework of this policy, local therapists are actively retraining as general practitioners. What is the difference between the categories “general practitioner” and traditionally accepted"local therapist"?

Retraining of specialists to provide general outpatient care to patients allowed us to take a more effective look at the entire issue of using the treatment capabilities of the relevant clinics and other medical institutions.

The key difference between a family doctor or general practitioner and a therapist who has dealt with this issue before is the possibility of behavior certain manipulations. This significantly expands the capabilities of a medical worker in comparison with those of a therapist.

For a long time, the therapist had only two key tools. This is a phonendoscope and tonometer. Of course, this was up to the standards of more than fifty years ago, since there weren't even many other types of instruments available before.

However, modern medical care and the availability of compact and very powerful devices for a wide variety of testing and examination present completely new challenges. requirements for specialists. General practitioners successfully master rhinoscopy, otoscopy and laryngoscopy at a high level. Now there is no need to go directly to the ENT specialist when your throat, ear or nose hurts.

There is no need to wait in two lines at once, first to see a therapist and then to an ENT specialist, since a general practitioner is able to examine these organs, make a decision and offer treatment for simple cases. Among other things, there is also the possibility analyze the fundus.

Of course, we are not talking about any narrow and deep professional research. However, a general practitioner has a diagnostic minimum, focused on identifying key aspects before referral to specialized specialists.

Such a specialist is able to record and decipher electrocardiogram data. In addition, the requirements for specialists who are located far from large cities and regional centers have increased significantly. Now such doctors are able to provide all stages of primary wound treatment and even apply plaster.

Of course, such a wide range of capabilities required from a general practitioner also leads to increased demands on his education. There is a certain basic concept, such as graduating from a medical school or university.

In this case, it does not make much difference what specialty the doctor received within the framework of specialized education. He can be either a therapist or a pediatrician. Afterwards, it is mandatory to undergo a residency in order to acquaint the future doctor with internal diseases and therapy. Pediatrics are also being explored.

If the education was received in the distant past, even an internship is necessary. After this, initial retraining is carried out in accordance with the specialty “general medical practice” or "family medicine". Of course, among specialists there is another option, for example, going to residency in a relevant specialty immediately after completing basic education.

Considering that all therapists who usually provided basic outpatient appointments will be qualified as family general practitioners, the number of new generalists in our country will gradually approach the total number of therapists now.

There is already an extremely extensive retraining program, which will provide the necessary knowledge to specialists so that they can fully implement the operations required of them.

Of course, the key features of a general practitioner lie precisely in his activities. It is worth noting that due to increased demands, reciprocal steps were taken towards doctors. As a result, GP sites are now reduced.

The maximum number of people assigned to a particular site cannot be more than 1800 people. It is worth noting that many systems remain quite familiar and understandable to experienced doctors. For example, the same surveillance system.

In case of vacation, the specialist is replaced by another doctor who works part-time during the absence of the site supervisor; he is responsible for everything that happens at the site. The duration of the vacation remains exactly the same as that of the therapist. In addition, a diagram is provided calling a specialist to your home. Home visits are carried out by a doctor on duty who is neither a therapist nor a general practitioner.

General practitioner (family doctor) is a doctor who has undergone special multidisciplinary training to provide primary health care to family members, regardless of their gender and age.

A specialist who has completed the training program in accordance with the qualification requirements and received a certificate is appointed to the position of GP. A general practitioner (GP) provides outpatient appointments and home visits, provides emergency care, carries out a range of preventative measures, therapeutic, diagnostic and rehabilitation measures, and assists in solving medical and social problems of the family.

On a contractual basis, GPs (GPs) can be assigned hospital beds. He also organizes hospital at home, day hospital.

The procedure for carrying out the activities of a general practitioner (family doctor) is established by the federal executive body in the field of health care and executive bodies of the constituent entities of the Russian Federation. ( Art.59. “Fundamentals of legislation on protecting the health of citizens, ed. Federal Law of August 22, 2004 No. 122-FZ).

A general practitioner must have knowledge both in the field of medicine and in other related specialties - psychology, sociology, social medicine, health economics, prevention, etc. His main task is to protect the health of the families he serves, provide primary health care, and treat patients independently depending on their age and type of disease.

The main function of a general practitioner is to provide multidisciplinary outpatient care to the population in accordance with the requirements of the qualification characteristics and the received certificate.

A general practitioner must have a basic therapeutic education, but since the scope of his activities is significantly expanding, he must have knowledge in related specialties and possess practical skills to implement various diagnostic and treatment methods currently performed by narrow specialists in outpatient clinics.

One of the most important functions of a general practitioner is the early detection of latent forms of the disease, the implementation of dynamic monitoring of the health status of patients with the necessary therapeutic and recreational measures and the involvement of specialists from various medical institutions for this purpose.

An important section of the activity of a general practitioner is conducting an examination of temporary disability, rational employment, and if there are signs of permanent disability, timely referral to medical examination.

In the activities of a general practitioner, a significant role should be given to the prevention of diseases, the organization of medical and social assistance to the lonely, elderly, disabled, and chronically ill (together with social protection authorities, charitable organizations, and mercy services). General practitioners must know the current legislation on social protection of these groups.

Among the main functions of a general practitioner, it is also necessary to note the provision of advisory assistance to families on issues of feeding, raising children, immunoprophylaxis, family planning, ethics and mental hygiene of family life.

An integral part of the work of a family doctor is maintaining approved records and reporting documentation.

Forms of organization of general medical practice: Solo practice and group practice.

Solo practice It is advisable to use mainly in rural areas.

Group practice the most appropriate form should be considered in cities (guidelines developed by the NGO Medsotsekonominform and approved by the Ministry of Health of the Russian Federation). It makes it possible to organize a doctor’s work more rationally and more fully satisfy the population’s needs for medical care. In this case, general practitioners work in a territorial clinic. They receive patients, use the services of specialist consultants, treatment and diagnostic rooms of the clinic (laboratory, x-ray, functional diagnostic rooms, physiotherapy rooms, etc.).

In order to make medical care more accessible to the population in certain areas, it is possible for polyclinics to organize separate offices for general practitioners. It should be considered preferable if the physician resides within the service area.

A general practitioner can be a private practitioner and serve the assigned population under an agreement with a medical institution.

Today, one of the most sought-after professions in medicine is a general practitioner. Almost every rural resident knows who he is. The fact is that it is in villages that doctors of this specialty most often work.

General practitioner: who is he?

The main difference between doctors of this specialty and others is that they have basic knowledge in each section of medicine. However, they are not required to provide specialized medical care.

They must be able to solve relatively simple health problems and engage in the prevention of therapeutic, surgical and gynecological diseases in both adults and children.

Why are general practitioners common in rural areas?

It is in villages that you can most often find such a specialist as a general practitioner. All the villagers know who he is. General practitioners are most widespread in this area due to the economic inefficiency of building full-fledged medical and preventive institutions in each locality and providing work for a large number of doctors there. From this point of view, it would be much more expedient to create small outpatient clinics staffed by a general practitioner (family doctor), a nurse and a nurse. Such a recruitment of employees will allow the outpatient clinic to provide comprehensive medical care to residents of the region attached to it.

For those remote from large centers, a general practitioner becomes a real salvation. All residents of agricultural regions know who this is, because it is to him that they go first. He is capable of performing the simplest surgical and gynecological manipulations, and is familiar with the therapeutic pathologies of both adults and children.

How is a GP trained?

This specialist, after graduating from a higher medical institution, must undergo an internship at one or more clinics. He needs to gain skills in therapeutic, surgical, pediatric, and gynecological profiles. As a result of such training, he becomes a specialist with general skills in diagnosing and treating diseases of any medical field.

How is the work of a general practitioner structured?

Prevention, diagnosis and treatment are all the main areas within which a general practitioner conducts his professional activities. His work is based primarily on identifying among the population living in the area under his control the risks of developing certain serious diseases, as well as systematic activities aimed at counteracting their formation.

What does a specialist need to work?

The general practitioner's office should be equipped with a number of tools that help carry out initial diagnosis. We are talking about a phonendoscope, tonometer, glucometer, thermometers, spatulas, laryngoscopes, otoscopes, rhinoscopes, ophthalmological and gynecological equipment. In addition, the general practitioner's outpatient clinic should have the simplest surgical instruments.

Ideally, the outpatient clinic can also be equipped with a mini-laboratory. It greatly simplifies the work of a general practitioner. Those specialists in this field who do not try to equip their outpatient clinics have to constantly refer patients to regional medical institutions for simple laboratory tests (general blood test, general urinalysis, biochemical blood test, etc.).

What services does a general practitioner provide to the population?

The work of this specialist is of great importance for the entire population served. Thanks to him, medical care becomes noticeably closer to people. Simple surgical procedures are performed in outpatient clinics. In addition, all conditions have been created here for injection (including in the form of droppers) administration of drugs. There is always a small bed capacity that allows patients to be placed in a hospital. That is, the patient can see a doctor and, if he deems it necessary, be treated without going to the hospital.

In large outpatient clinics, in addition to a regular specialist, a general dentist may also work.

If a person becomes very ill and cannot visit a doctor on his own, he has the opportunity to call him to his home. Moreover, most often a specialist of this profile attends such calls after lunch, and the appointment at the outpatient clinic is carried out before lunch.

Economic feasibility of outpatient clinics

Such institutions and the position of “general practitioner” (we have already found out who this is) were introduced not only to bring medical care closer to the population of rural areas. The fact is that it is also beneficial from an economic point of view. Firstly, there is no need to refer a therapist, gynecologist, surgeon, ophthalmologist, otorhinolaryngologist and others separately here. A general practitioner can handle all relatively simple problems. Those who present more serious complaints, or whose health condition causes concern to this doctor, are sent to higher-level health care institutions.

Prospects for the development of the profession in the future

Currently, a general practitioner (who is this, was described above) is not the most common, but at the same time a very necessary profession. This specialist is in demand in rural areas. At the same time, such a doctor saves the state significant funds, because in every locality it is not necessary to maintain a large healthcare institution in which a large number of doctors work. A general practitioner can handle many problems on his own. If the intervention of specialized specialists is required to combat a particular pathology, the patient will be sent to a medical center of the appropriate profile.

In the future, a general practitioner may be re-registered as a so-called family doctor. This specialist is a doctor who provides medical care to several families. He knows each of his patients very well. A small number of them allows him to delve into the problems of all his charges as deeply as possible. Family doctors are a very effective way to preserve the health of the population, but the activities of such specialists are possible only in a sufficiently developed economy. The fact is that the salary of such an employee will consist of contributions from his direct patients. So the family doctor, if we talk about the widespread activities of such specialists, remains a prospect for the future. In many European countries, the institute of family doctors has existed for quite a long time and has proven its effectiveness. At the same time, the basis of the activities of such specialists is prevention and early diagnosis of any diseases.

In addition, the profession of a general practitioner himself is promising. Mobile complexes are now being created that can significantly expand the capabilities of a given doctor in the field of diagnosing certain diseases. We are talking about so-called specialized general practitioner cars. This complex includes a small laboratory, as well as a set for conducting the most important instrumental studies.

In the future, the number of offices will increase as the retraining of therapists continues. This year alone the number of general practitioners will increase to three thousand.

General practitioners' offices have been equipped in all the capital's clinics. This is more than two thousand premises for reception and about 550 manipulation rooms.

“Most patients in clinics come for appointments with general practitioners. Such a specialist can carry out the simplest medical procedures, so additional technical equipment is needed in his office. Since March last year, we have purchased and supplied more than 15 thousand units of medical equipment needed by a general practitioner to clinics. These are otoscopes, rhinoscopes, ophthalmoscopes, non-contact tonometers and other equipment,” noted the Minister of the Moscow Government, the head of the city of Moscow.

The head of the department also noted that the number of such offices will gradually increase. This year, the number of general practitioners who will provide primary care to patients will increase to three thousand people.

General practitioners are therapists who have undergone professional retraining and have specialized knowledge in the field of otolaryngology, ophthalmology, neurology and surgery. All general practitioners receive a monthly incentive bonus of 20 thousand rubles in accordance with a grant established by the Moscow Government.

Compared to local therapists, they can perform simple medical procedures without referring the patient to a specialist. For example, a general practitioner can measure eye pressure on site, perform an electrocardiogram (ECG) or otoscopy.

Moscow doctors also receive other bonuses for successful work. Thus, awarded specialists receive additional monthly payments in the amount of 15 thousand rubles. The best doctors are selected in 15 specialties; by the end of the year the number of nominations will increase to 20. Honorary status is issued for five years.

Incentive payments are also received by doctors (20 thousand rubles per month) and nurses (10 thousand rubles per month) participating in the implementation of the program. The Moscow government has also approved a grant, according to which doctors and nurses providing patronage medical care at home are paid an additional 25 thousand and 15 thousand rubles per month, respectively, for special working conditions.

In addition, to support both individual clinics and areas of primary medical care, the Moscow Government has established a series of grants. For example, 19 clinics and diagnostic centers have already received grants. The amount of payments amounted to 115 million rubles.

Eight clinics also received grants worth 39 million rubles. They were awarded for the best organization of preventive work with residents in the categories “Policlinic with the best health school”, “Polyclinic with the best prevention department”, “Polyclinic with the greatest coverage of the population with medical examination”, “Polyclinic with the greatest increase in the share of the attached population undergoing medical examination in one year ", "A clinic with the best organization of medical care in an educational organization."

And in February, two city clinics of the Moscow Government were awarded for their successful work in creating a comfortable environment and high quality of patient care. These are diagnostic center No. 3 (South Eastern Administrative District) and children's city clinic No. 132 (ZAO). The total amount of payments was 15 million rubles - 7.5 million for each institution.

Recently, in sick leave certificates in the column “position of the attending physician” you can see the abbreviation GP.

The question arises, what does this abbreviation mean?

According to Nomenclature of positions of medical workers, there is a specialty of a doctor called a general practitioner or family doctor.

Let's try to figure out what kind of specialty this is.

The difference between a general practitioner and a therapist

General practitioner, traditionally also called family doctor, provides medical care on an outpatient basis. That is, in the clinic, the so-called primary care, where the sick person goes. The main difference between a general practitioner and a therapist is volume of practical work performed, because he has the right to carry out a whole range of manipulations.

The therapist uses only such tools as a tonometer and a phonendoscope, but a family doctor has the right to perform otoscopy, laryngoscopy and rhinoscopy. Simply put, he has skills that allow him to examine the ears, nasopharynx, and even the fundus of the eye.

The doctor has the ability to conduct diagnostic minimum in some narrow medical specialties. Also, a general practitioner has the right to interpret an electrocardiogram, and in small towns he is charged with treating wounds and applying plaster casts, in the absence of appropriate specialists.

What education does a general practitioner receive?

Basic education for a general practitioner is studying at a medical university, in which the graduate is certified as a general practitioner or pediatrician. Then you need to complete a residency in the field of “therapy,” “pediatrics,” or “internal medicine,” and perhaps even undergo an internship.

If a general practitioner received his education a long time ago, he has the right to undergo advanced training to obtain the specialty “General Medical Practice (Family Medicine), having undergone retraining.

At this stage in Russia there are approximately the same number of general practitioners as there are therapists. Thanks to retraining programs, therapists retrain and get positions family doctors or general practitioners, it depends on the place where they plan to work. The number of such doctors is constantly growing.

What is the job of a family doctor?

A general practitioner is assigned a smaller area than a therapist, because he has more responsibilities in relation to each patient. Usually about 1800 patients, but it all depends on the locality in which the doctor practices.

For example, in Moscow a family doctor deals only with adult patients, while children are supervised by a pediatrician, while the observation system and call system are similar to those used by a local physician. When a family doctor goes on vacation, another doctor comes in to replace him and is given responsibility for the entire area. The duration of vacations for general practitioners and therapists is the same.

However, the family doctor and internist do not visit sick people The doctor on duty responds to calls. In some cases, when there is a need for a visit, the family doctor visits the patient outside of working hours.

What to do if the general practitioner was unable to make a diagnosis?

The higher the professionalism of a general practitioner, the greater the capabilities he has and the less he needs advice from other specialists. But when they arise highly professional questions, the family doctor refers the patient to the appropriate specialist or to a separate medical institution that provides specialized care.

As an example, consider the option when a patient suffers from arterial hypertension (hypertension). This disease is within the competence of internists, family doctors and cardiologists. There are no indications to redirect the patient to a cardiologist, since a qualified general practitioner is able to examine such a patient and prescribe him treatment.

But if the patient is diagnosed with coronary heart disease, then he may need the intervention of a surgeon; naturally, in this case, the family doctor will refer the patient to a specialized specialist.

Also, when a family doctor believes that he cannot cope with the situation and the treatment he prescribes does not give the desired effect, he has the right to ask for help from another specialist, that is to get a consultation. General practitioners often use this opportunity.

Of course, the regulatory documents specify the level of competence of a family doctor. At the same time, these documents are constantly being revised, taking into account precedents arising in practice. The standards developed in this way determine what types of examinations and manipulations the doctor will have the right to perform.