The Scope of GP Practice and Consent

Duty of Care

In Australia, general practitioners are the primary port of call for our general health maintenance and are more often than not, the first person we consult for our health concerns.  

Many of us attend the same general practitioner for years, we often refer our loved ones and form a close relationship with our GP’s. Due to the nature of the doctor patient relationship we tend to form a high level of trust in the treatment and advice they provide as medical professionals.

In any relationship between a doctor and patient a duty of care exists. As a general practitioner, a duty of care is owed to the patient to: -

• Provide medical care to the standard of a reasonably competent general practitioner  
• To provide correct timely advice to the patient to the standard of a reasonably competent general practitioner
• To provide treatment that is necessary and warranted
• To warn of risks of such treatment that would be of significance to that particular patient

While this is not an exhaustive list, it is clear that a general practitioner must act in accordance with the duty of care at all times during their professional practice. This duty cannot be waived on the basis of a longstanding doctor patient relationship. The duty must be upheld in all circumstances.

Informed Consent

It was established in Rogers v Whitaker (1992) 175 CLR 479 that practitioners must warn their patients of any risks that would be of significance to that particular patient. Prior to undertaking any procedure, your GP must first warn you of the associated risks and provide your informed consent.

It is important to know that even if a consent form is signed by a patient, very little weight is given to that consent form if a patient can prove they were not appropriately advised of the particular risk of that procedure, or if their GP failed to advise of alternative treatments that may be better suited to that particular patient and their circumstances.

That being said, if consent is given for a procedure that falls outside a general practitioners scope of practice and qualification, it is irrelevant if consent is given as that treatment would be considered a breach of duty of care.

Scope of Practice

It is of the upmost importance for general practitioner to recognise the limit of their experience and qualification while practicing in their professional capacity as general practitioner in Australia, as well as the significance of informed consent.

McInnes Wilson Lawyers have been investigating claims in which patients have trusted and accepted the advice and treatment recommendations of their GP and have consented to treatment which their practitioners did not hold qualifications in Australia to undertake, and which fell outside the scope of practice in Australia resulting in the patients suffering loss, damage, and disability.

Our investigations concern patients who attended upon their general practitioner for excision of sun damaged skin/lesions and/or moles. Generally excision for biopsy is a small surgical procedure which is not considered high risk and can be undertaken by an appropriately trained general practitioner.

In this case, following the return of the initial biopsy results the general practitioner proceeded to recommend and undertake a large excision and graft to the patient’s chest. Subsequently the tissue became necrotic resulting in permanent scarring and disfigurement.

Our experts have advised that the general practitioner breached their duty of care by offering a surgery that was firstly incorrect, and secondly an extensive procedure that fell well outside the scope of general practice.

This type of extensive surgical procedures should be undertaken by appropriately trained specialists in plastic surgery or specialist dermatologist as recognised by AHPRA.

Further, our experts advised that to perform such an invasive and extensive surgery in a general practice environment was not only inappropriate but also increased the risk of complications such as infection.

These cases raise important issues about the scope of a general practitioners practice and what treatment falls within the scope of a GP practicing in Australia.

Treatment in Clinics

Generally speaking, a general practitioner’s practice in clinics is limited to: -

• Minor biopsies of skin lesions
• Lancing abscess
• Skin tag removal
• Foreign body removal
• Freezing treatments
• Minor suturing
• Injections

What is certain is that extensive surgical procedures do not fall within the scope of general practitioners practicing in Australia, and should not be undertaken in general practice clinics.

If your GP is offering services over and above what would be considered a minor procedure, or if you are recommended treatment on a highly visible area such as your hands, décolletage, neck, or face, you should seek a second opinion from an appropriately trained medical specialist.

If you feel the advice you received from your general practitioner falls outside the qualifications and scope of practice of a general practitioner you should seek a second opinion.