Principles of General Practice and Primary Care
What this domain tests
The CKT probes whether you apply the defining features of generalist care - first contact, undifferentiated presentation, continuity, and stewardship of the primary–secondary interface - inside Irish structures: the GMS contract, GP visit cards, the Chronic Disease Management (CDM) programme and PCRS claiming.
Core rules
- Probability before pathology. Pre-test probability of serious disease is low in general practice, so a positive result carries a low positive predictive value; incidental findings and false-positive cascades are the main harm of unfocused testing. Order a test only if a plausible result would change management.
- Pattern is data. Repeat attendance with the same vague symptom is itself a diagnostic finding and should trigger a freshly taken history rather than a repeated test.
- The interface is a clinical resource. Advice-and-guidance lines and e-referrals should be used when the question is narrow, reserving open referral for diagnostic uncertainty.
- CDM reviews are opportunistic. Every contact with a patient who has diabetes, asthma, COPD, ischaemic heart disease or heart failure is a chance to complete and correctly code a structured review; uncoded work is neither paid nor recallable.
- Inverse care law. Those with greatest need attend least; prevention must be offered at every contact, not only at dedicated checks.
Worked example
A 34-year-old attends a third time with fatigue; FBC at visit one was normal. Recognising the pattern, you retake the history and elicit night sweats and 6 kg weight loss. You request ESR, CRP and a chest X-ray and refer that week. The reasoning: the repetition, not the original test, changed the probability and justified escalation.
Traps that cost marks
- Ordering a broad "screen" instead of a focused question.
- Assuming a hospital letter closes the loop - the GP retains responsibility for follow-up.
- Forgetting a patient may be GMS for one item and private for another.
- Failing to document an informed refusal of referral.