Job description of a general practitioner (family doctor). General Family Practitioner

We bring to your attention a typical example of a job description for a general practitioner (family doctor), sample 2019/2020. should include the following sections: general position, duties of a general practitioner (family doctor), rights of a general practitioner (family doctor), responsibility of a general practitioner (family doctor).

Job description general practitioner (family doctor) belongs to the section Qualification characteristics health worker positions".

The job description of a general practitioner (family doctor) should include the following items:

Job responsibilities of a general practitioner (family doctor)

1) Job responsibilities. Carries out outpatient reception and home visits, provides emergency care, conducts a set of preventive, therapeutic, diagnostic and rehabilitation measures, assists in solving medical and social problems of the family. Provides continuous primary health care to the patient, regardless of his age, gender and nature of the disease. Examines and evaluates the patient's physical examination data. Makes a plan for laboratory, instrumental examination. Interprets laboratory test results; radiation, electrophysiological and other research methods; independently conducts examination, diagnosis, treatment, rehabilitation of patients, if necessary, organizes additional examination, consultation, hospitalization of patients, subsequently makes appointments and carries out further monitoring in the most common diseases. Provides: obstetric care, care for children and patients with occupational diseases, medical care in acute and urgent conditions of the body requiring resuscitation, intensive care. Conducts an analysis of the health status of the attached contingent, disease prevention, measures to improve the health of the population, including the formation healthy lifestyle life, reducing the consumption of alcohol and tobacco, maintains accounting and reporting medical documentation. Carries out preventive work aimed at identifying early and latent forms of diseases, socially significant diseases and risk factors through medical examination of the attached contingent in the prescribed manner, including children, the disabled, people of older age groups. Refers patients for consultations to specialists for inpatient and rehabilitation treatment medical indications. Organizes and conducts treatment of patients on an outpatient basis, a day hospital and a hospital at home. Carries out patronage of pregnant women and young children, including newborns, in the prescribed manner. Organizes and conducts anti-epidemic measures and immunoprophylaxis in the prescribed manner. Issues a conclusion on the need to refer patients for medical reasons for sanatorium treatment. Interacts with medical organizations state, municipal and private systems healthcare, insurance medical companies, other organizations. Supervises the work of middle and junior medical staff. Increases in due course professional qualification. Prepares and sends an emergency notification to the institution of Rospotrebnadzor when an infectious disease is detected. Conducts an examination of temporary disability, sends patients with signs of permanent disability for examination for medical and social examination.

General practitioner (family doctor) should know

2) General practitioner (family doctor) when performing their official duties must know: constitution Russian Federation; laws and other regulatory legal acts of the Russian Federation in the field of healthcare, consumer protection and sanitary and epidemiological welfare of the population; normative legal acts regulating the circulation of potent, psychotropic and narcotic drugs; theoretical basis in the chosen specialty; prevention, diagnosis, treatment of the most common diseases and rehabilitation of patients, principles and methods of prevention and treatment of the most common diseases; rehabilitation of patients; demographic and medical and social characteristics of the attached contingent; issues of organizing medical and social expertise; basics of dietary nutrition and diet therapy; on the territorial program of state guarantees to provide citizens with free medical care(types of medical care provided to the population free of charge, medical care provided within the framework of the territorial program of compulsory medical insurance, medical care provided at the expense of budgets of all levels); the procedure for referring patients to sanatorium treatment; fundamentals of labor legislation; labor protection rules and fire safety; sanitary rules and norms for the functioning of a healthcare institution.

Requirements for the qualification of a general practitioner (family doctor)

3) Qualification requirements. Higher professional education in one of the specialties "General Medicine", "Pediatrics" and postgraduate professional education (residency) in the specialty "General Medical Practice (Family Medicine)" or professional retraining in the specialty "General Medical Practice (Family Medicine)" in the presence of a postgraduate professional education in the specialty "Pediatrics" or "Therapy", a certificate of a specialist in the specialty "General Medical Practice (Family Medicine)", without presenting requirements for work experience.

Job description of a general practitioner (family doctor) - sample 2019/2020. The duties of a general practitioner (family doctor), the rights of a general practitioner (family doctor), the responsibility of a general practitioner (family doctor).

APPROVE:

[Job title]

_______________________________

_______________________________

[Name of company]

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_______________________/[FULL NAME.]/

"______" _______________ 20___

JOB DESCRIPTION

General practitioner

1. General Provisions

1.1. This job description defines and regulates the powers, functional and job duties, rights and responsibilities of a general practitioner [Name of organization in the genitive case] (hereinafter referred to as the Medical Organization).

1.2. A general practitioner is appointed and dismissed in accordance with the procedure established by the current labor legislation by order of the head of the Medical Organization.

1.3. A general practitioner belongs to the category of specialists and is subordinate to [name of the position of subordinates in the dative case].

1.4. The General Practitioner reports directly to [title of the immediate supervisor in the dative case] of the Medical Organization.

1.5. A person who has a higher professional education in one of the specialties "Medicine", "Pediatrics" and postgraduate professional education (residency) in the specialty "General Medical Practice (Family Medicine)" or professional retraining in the specialty "General Medicine" is appointed to the position of a general practitioner. practice (family medicine)" with postgraduate professional education in the specialty "Pediatrics" or "Therapy", a certificate of a specialist in the specialty "General Medical Practice (Family Medicine)", without presenting requirements for work experience.

1.6. The general practitioner is responsible for:

• effective performance of the work entrusted to him;
• compliance with the requirements of performance, labor and technological discipline;
• the safety of the documents (information) that are in his custody (become known to him), containing (constituting) the trade secret of the Medical Organization.

1.7. The general practitioner should know:

• the Constitution of the Russian Federation;
• laws and other regulatory legal acts of the Russian Federation in the field of healthcare, consumer protection and sanitary and epidemiological welfare of the population;
• normative legal acts regulating the circulation of potent, psychotropic and narcotic drugs;
• theoretical foundations in the chosen specialty;
• prevention, diagnosis, treatment of the most common diseases and rehabilitation of patients, principles and methods of prevention and treatment of the most common diseases;
• rehabilitation of patients;
• demographic and medical and social characteristics of the attached contingent;
• issues of organizing medical and social expertise;
• basics of dietary nutrition and diet therapy;
• on the territorial program of state guarantees for the provision of free medical care to citizens (types of medical care provided to the population free of charge, medical care provided under the territorial program of compulsory medical insurance, medical care provided at the expense of budgets of all levels);
• the procedure for referring patients to sanatorium treatment;
• fundamentals of labor legislation;
• rules on labor protection and fire safety;
• sanitary rules and norms for the functioning of a healthcare institution.

1.8. The general practitioner in his work is guided by:

• local acts and organizational and administrative documents of the Medical Organization;
• internal labor regulations;
• rules of labor protection and safety, ensuring industrial sanitation and fire protection;
• instructions, orders, decisions and instructions of the immediate supervisor;
• this job description.

1.9. During the period of temporary absence of a general practitioner, his duties are assigned to [name of the position of the deputy].

2. Job responsibilities

A general practitioner is required to perform the following labor functions:

2.1. Carries out outpatient reception and home visits, provides emergency care, conducts a set of preventive, therapeutic, diagnostic and rehabilitation measures, assists in solving medical and social problems of the family.

2.2. Provides continuous primary health care to the patient, regardless of his age, gender and nature of the disease.

2.3. Examines and evaluates the patient's physical examination data.

2.4. Makes a plan for laboratory, instrumental examination.

2.5. Interprets laboratory test results; radiation, electrophysiological and other research methods.

2.6. Independently conducts examination, diagnosis, treatment, rehabilitation of patients, if necessary, organizes additional examination, consultation, hospitalization of patients, subsequently makes appointments and carries out further monitoring in the most common diseases.

2.7. Provides: obstetric care, assistance to children and patients with occupational diseases, medical care in acute and urgent conditions of the body requiring resuscitation, intensive care.

2.8. Carries out an analysis of the health status of the attached contingent, disease prevention, measures to improve the health of the population, including the formation of a healthy lifestyle, reducing alcohol and tobacco consumption, and maintains accounting and reporting medical documentation.

2.9. Carries out preventive work aimed at identifying early and latent forms of diseases, socially significant diseases and risk factors through medical examination of the attached contingent in the prescribed manner, including children, the disabled, people of older age groups.

2.10. Refers patients for consultations to specialists for inpatient and rehabilitation treatment for medical reasons.

2.11. Organizes and conducts treatment of patients on an outpatient basis, a day hospital and a hospital at home.

2.12. Carries out patronage of pregnant women and young children, including newborns, in the prescribed manner.

2.13. Organizes and conducts anti-epidemic measures and immunoprophylaxis in the prescribed manner.

2.14. Issues a conclusion on the need to refer patients for medical reasons for sanatorium treatment.

2.15. Interacts with medical organizations of the state, municipal and private healthcare systems, medical insurance companies, and other organizations.

2.16. Supervises the work of middle and junior medical staff.

2.17. Improves professional qualifications in accordance with the established procedure.

2.18. Prepares and sends an emergency notification to the institution of Rospotrebnadzor when an infectious disease is detected.

2.19. Conducts an examination of temporary disability, sends patients with signs of permanent disability for examination for medical and social examination.

In case of official necessity, a general practitioner may be involved in the performance of his official duties overtime, in the manner prescribed by the provisions of federal labor legislation.

3. Rights

The general practitioner has the right:

3.1. Give instructions to subordinate employees and services, tasks on a range of issues included in his functional responsibilities.

3.2. To control the fulfillment of production tasks, the timely execution of individual orders and tasks by subordinate services.

3.3. Request and receive the necessary materials and documents related to the activities of a general practitioner, his subordinate services and units.

3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of a general practitioner.

3.5. Sign and endorse documents within their competence.

3.6. Submit for consideration by the head of the Medical Organization submissions on the appointment, transfer and dismissal of employees of subordinate units; proposals for their promotion or for the imposition of penalties on them.

3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.

4. Responsibility and performance evaluation

4.1. The general practitioner bears administrative, disciplinary and material (and in individual cases provided for by the legislation of the Russian Federation - and criminal) liability for:

4.1.1. Non-fulfillment or improper fulfillment of official instructions of the immediate supervisor.

4.1.2. Failure to perform or improper performance of their labor functions and assigned tasks.

4.1.3. Unlawful use of the granted official powers, as well as their use for personal purposes.

4.1.4. Inaccurate information about the status of the work entrusted to him.

4.1.5. Failure to take measures to suppress the identified violations of safety regulations, fire and other rules that pose a threat to the activities of the enterprise and its employees.

4.1.6. Failure to enforce labor discipline.

4.2. Evaluation of the work of a general practitioner is carried out:

4.2.1. The immediate supervisor - regularly, in the course of the daily implementation by the employee of his labor functions.

4.2.2. Certification Commission enterprises - periodically, but at least once every two years based on the documented results of work for the evaluation period.

4.3. The main criterion for evaluating the work of a general practitioner is the quality, completeness and timeliness of his performance of the tasks provided for by this instruction.

5. Working conditions

5.1. The work schedule of a general practitioner is determined in accordance with the internal labor regulations established by the Medical Organization.

6. Right to sign

6.1. To ensure his activities, a general practitioner is granted the right to sign organizational and administrative documents on issues referred to his competence by this job description.

Familiarized with the instruction ___________ / ____________ / "____" _______ 20__

1. General Provisions

1. This job description defines the job duties, rights and responsibilities of a general practitioner (family doctor).

2. A person with a higher medical education who has completed postgraduate training or specialization in the specialty "General Medical Practice (Family Medicine)" is appointed to the position of a general practitioner (family doctor).

3. A general practitioner (family doctor) must know the basics of the RF legislation on health care; legal documents regulating the activities of health care institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply to the population and health care facilities; theoretical foundations, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the context of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects medical activities; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.

In his specialty, a general practitioner (family doctor) must know modern methods prevention, diagnosis, treatment and rehabilitation; content and sections of general medical practice (family medicine) as an independent clinical discipline; tasks, organization, structure, staffing and equipment of the service of general medical practice (family medicine); current legal and instructive and methodological documents in the specialty; rules for issuing medical documentation; the procedure for conducting an examination of temporary disability and medical and social examination; principles of activity planning and reporting of the service of general medical practice (family medicine); methods and procedures for monitoring its activities.

4. A general practitioner (family doctor) is appointed to the position and dismissed by the order of the head physician of the health facility in accordance with current legislation RF.

5. A general practitioner (family doctor) reports directly to the head of the department, and in his absence to the head of the health facility or his deputy.

2. Job responsibilities

Provides qualified medical care in his specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, approved for use in medical practice. Determines the tactics of managing the patient in accordance with the established rules and standards, develops a plan for examining the patient, clarifies the volume and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time. Based on clinical observations and examinations, anamnesis, data from clinical, laboratory and instrumental studies, establishes (or confirms) the diagnosis. In accordance with the established rules and standards, appoints and controls the necessary treatment, organizes or independently conducts the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and measures. Makes changes to the treatment plan depending on the patient's condition and determines the need additional methods examinations. Provides consultative assistance to doctors of other departments of health care facilities in their specialty. Supervises the work of secondary and junior medical personnel subordinate to him (if any), ensures compliance with the performance of his duties. Controls the correctness of diagnostic and therapeutic procedures, operation of instruments, apparatus and equipment, rational use reagents and medicines, observance of safety regulations and labor protection by middle and junior medical personnel. Participates in training sessions to improve the skills of medical personnel. Plans its work and analyzes the performance of its activities. Ensures timely and high-quality execution of medical and other documentation in accordance with established rules. Carries out sanitary-educational work. Complies with the rules and principles of medical ethics and deontology. Participates in the examination of temporary disability and prepares Required documents for medical and social expertise. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on his professional activities. Complies with internal regulations fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

A general practitioner (family doctor) has the right to:

1) independently establish a diagnosis in the specialty on the basis of clinical observations and examinations, anamnesis, data from clinical, laboratory and instrumental studies; determine the tactics of patient management in accordance with established rules and standards; prescribe the methods of instrumental, functional and laboratory diagnostics necessary for a comprehensive examination of the patient; carry out diagnostic, therapeutic, rehabilitation and preventive procedures using approved diagnostic and treatment methods; to involve, in necessary cases, doctors of other specialties for consultations, examination and treatment of patients;

2) to make proposals to the management of the institution on improving the diagnostic and treatment process, improving the work of administrative, economic and paraclinical services, issues of organization and conditions of their labor activity;

3) control the work of subordinate employees (if any), give them orders within their official duties and demand their precise execution, make proposals to the management of the institution on their encouragement or imposition of penalties;

4) request, receive and use information materials and legal documents necessary for the performance of their duties;

5) to take part in scientific and practical conferences and meetings, at which issues related to his work are considered;

6) pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;

7) improve their qualifications at refresher courses at least once every 5 years.

General practitioner (family doctor) enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The general practitioner (family doctor) is responsible for:

1) timely and high-quality implementation of the duties assigned to him;

2) organization of their work, timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts on their activities;

3) compliance with internal regulations, fire safety and safety;

March 21, 2017 by order of the Ministry of Labor and social protection The Russian Federation No. 293n approved the professional standard "General practitioner (district physician)".

We remind you that in accordance with Article 195.1 Labor Code RF professional standard - a characteristic of the qualifications necessary for an employee to implement a certain kind professional activity, including the performance of a certain labor function. According to part 1 of the article, if the Labor Code, other federal laws, other regulatory legal acts The Russian Federation establishes requirements for the qualifications necessary for an employee to perform a certain labor function, professional standards in terms of these requirements are mandatory for employers to apply.

Considering the existing qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health care and medical sciences", approved by order of the Ministry of Health of Russia dated 08.10.2015 No. 707n, section "Qualification characteristics of positions of workers in the field of healthcare" of the Unified qualification handbook positions of managers, specialists and employees, approved by order of the Order of the Ministry of Health and Social Development of the Russian Federation of July 23, 2010 No. 541n and a number of other regulatory legal acts, professional standards are mandatory in terms of requirements for education, training, level of knowledge, skills and abilities of medical workers (more about this can be read in the articles and "" and "").

Currently, the following professional standards for medical workers have been approved in the Russian Federation:

• Professional standard ""
• Professional standard " Specialist in the field of medical and preventive affairs»
• Professional standard " Junior medical staff»
• Professional standard "Dentist"
• Professional standard "Pharmacist"
• Professional standard " District pediatrician»

Undoubtedly, the professional standard "General practitioner (district physician)" is one of the key professional standards in the field of healthcare, since it is "on the shoulders" of district general practitioners that a significant part of the primary medical care is provided.

In accordance with the accepted standard, the main goal of the activity of medical doctors is defined as "preserving and strengthening the health of the adult population." This definition raises some questions. So, if you believe the professional standard, The main purpose of the activity of a medical doctor is not just the treatment of diseases. The wording "preservation and promotion of health" is taken from article 12, paragraph 5 federal law dated November 21, 2011 No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" and it denotes the implementation of prevention in the field of health protection.

As generalized labor function The standard provides for the performance by these specialists of the functions of providing primary health care to the adult population on an outpatient basis, which does not provide for round-the-clock medical supervision and treatment, including at home when a medical worker is called.

as possible job titles and professions only one name is provided - "district physician". Thus, we can expect that a separate professional standard will be devoted to the ordinary general practitioner.

At the same time, it is surprising that there is no such job title as “doctor-therapist of the local shop medical district”. Despite the fact that this position is much less common than a district therapist, it is provided for by such regulatory legal acts as qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health and medical sciences", approved by order of the Ministry of Health of Russia dated 08.10 .2015 No. 707n and the nomenclature of positions of medical workers and pharmaceutical workers, approved by order of the Ministry of Health of the Russian Federation dated December 20, 2012 No. 1183n. Of course, there is a possibility of a separate standard for this position (but is it necessary?) - but before such an appearance, there is a certain gap in the characterization of the qualifications necessary to perform the functions of a local general practitioner in a shop medical department.

Education and training requirements district general practitioner, in accordance with the professional standard, include the following:

• higher education - a specialist in the specialty "General Medicine" who completed their studies in accordance with the federal educational standard higher education since 2017;
• higher education - a specialist in the specialties "Pediatrics" or "General Medicine";
• training in internship / residency in the specialty "Therapy";
• additional professional education - professional retraining in the specialty "Therapy" in the presence of training in residency in the specialty "General Medical Practice (Family Medicine)".

It can be concluded that the authors professional standard focused on the qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health and medical sciences", approved by the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n (requirement 2-4), as well as the order of the Ministry of Education and Science of Russia dated 12.09. 1061 "On approval of the lists of specialties and areas of higher education training" (requirement 1).

However, the edition of the requirements for education proposed by the professional standard suggests a misinterpretation, according to which, in order to work as a local general practitioner, it is enough to fulfill one of the above requirements (as well as one might think that all 4 requirements must be met). In fact, the first requirement (a specialist in the specialty "Medicine" who completed their studies in accordance with the federal educational standard of higher education since 2017) should logically apply exclusively to graduates of medical universities, who are now authorized (almost) to start working after passing primary accreditation, bypassing the residency stage. The rest of the requirements obviously refer to “full-fledged” doctors who also received postgraduate education in internship / residency, while the third requirement (training in internship / residency in the specialty "Therapy") and the fourth requirement (APE) are directly linked to the fulfillment of the second (higher education - a specialist in the specialties "Pediatrics" or "General Medicine") and do not have the right to "independent life".

In addition, the new professional standard there is no possibility of appointing district doctors with the specialty "General Medical Practice (Family Medicine)" to the position of a general practitioner, despite the fact that this appears in the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n. Qualifications to education in this case are as follows: higher education - a specialist in one of the specialties: "General Medicine", "Pediatrics", residency training in the specialty "General Medical Practice (Family Medicine)" or professional retraining in the specialty "General Medical Practice (Family Medicine)" medicine)" with higher education (residency) in one of the specialties: "Pediatrics", "Therapy". However, we repeat that these norms are not reflected in the professional standard.

If we set the goal of full compliance of the professional standard with the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n and the logic of the order of the Ministry of Education and Science of Russia dated 12.09.2013 No. 1061, then the requirements for education and training should have such an edition (three alternative options for the education and training requirements of a district general practitioner should be identified):

• I. Higher education - a specialist in the specialty "General Medicine" who completed their studies in accordance with the federal educational standard of higher education since 2017.
• II. Higher education - a specialist in the specialties "Pediatrics" or "General Medicine":
  • a) with training in internship / residency in the specialty "Therapy";
  • b) with an additional vocational education - professional retraining in the specialty "Therapy" with training in residency in the specialty "General Medical Practice (Family Medicine)".
• III. Higher education - a specialist in the specialties "Pediatrics" or "General Medicine":
  • a) with training in internship / residency in the specialty "General Medical Practice (Family Medicine)";
  • b) with additional professional education - professional retraining in the specialty "General Medical Practice (Family Medicine)" in the presence of training in residency in one of the specialties: "Pediatrics", "Therapy".

However, we believe that such an approach is inconsistent with modern approaches to medical education and needs to change.

So, in the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n there are no requirements for the specialty "General Medicine", which is not so surprising, because the specialty "General Medicine" was recently (January 2017) added to the Nomenclature of specialties of specialists with higher medical and pharmaceutical education, approved by the Order of the Ministry of Health of Russia dated October 7, 2015 No. 700n. Do not confuse medical and pharmaceutical specialties with educational specialties, but it is also worth noting that the Ministry of Health and APE organizations have long confused these two concepts, which is legally incorrect.

According to the order of the Ministry of Education and Science of Russia dated September 12, 2013 No. 1061 "On approval of the lists of specialties and areas of higher education training" "physician" is a qualification corresponding to the specialty 31.05.01 - General Medicine (level of education - specialty). At least this has been the case since May 22, 2017, before that, the specialty 05/31/01 - General Medicine corresponded to the qualification "General Practitioner". The qualification "doctor-therapist" is a qualification, corresponding specialty 31.08.49 - Therapy (level of education - residency).

Please note that different levels of education and different qualifications can in no way imply holding the same position.. In our opinion, the position of the authors of the standard, identifying the "medical doctor" with the "district general practitioner" is erroneous- since the first requires only higher education in the form of a specialist, and the second requires postgraduate education (with internship / residency training). It is quite logical that the range of labor functions and duties of a doctor with a postgraduate education should be wider than that of a specialist who has just graduated from a medical university. The positions and functions of specialists with a specialist education level and specialists with a highly qualified personnel education level cannot be identical. Firstly, this is logical, and secondly, it follows from part 9 of article 82 of the Law on Education, which states that training in residency programs ensures that students acquire the level of knowledge, skills and abilities necessary for their professional activities, as well as qualifications to take certain positions medical workers, pharmaceutical workers.

In this way, according to the Faculty of Medical Law, it is necessary to allocate two positions with different requirements for them and with different labor functions: "physician"(for university graduates who do not have postgraduate education in the form of internship / residency) and a general practitioner(for university graduates with internship/residency training”).

Accordingly, it is desirable to develop a professional standard for each of the positions, or at least provide for differences in their labor functions ( labor activities required knowledge and skills). Also it is necessary to amend the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n, clearly defining the requirements for the specialty "General Medicine".

We also consider it expedient to make a clearer distinction between the positions of a general practitioner (family doctor) and a district physician. As already mentioned above, order of the Ministry of Health of Russia dated 08.10.2015 No. 707n provides for the work of a doctor with the specialty "General Medical Practice (Family Medicine)" as a district general practitioner without retraining. At the same time, this order does not allow a doctor with a specialty "therapy" to work as a family doctor without retraining. In our opinion, there is no reason to believe that doctors with the specialty "family medicine" have a greater amount of knowledge and skills than doctors with the specialty "therapy".

Given the above, it seems to us that the norms of the order of the Ministry of Health of Russia dated 08.10.2015 No. 707n require adjustments(either in the form of creating a separate position for family doctors working at the district, or in the form of an exception from the text of the order of the norms that allow family doctors, without undergoing retraining, to hold the position of a district general practitioner). At the same time, to finalize possible changes in the legislation concerning family doctors will become possible only after the release of the professional standard "Family Doctor". However, this order requires a separate legal analysis, which is not the purpose of this article.

Experience Requirements practical work there are none for a general practitioner, which is quite natural, since the position of a local general practitioner is often one of the first steps in a young doctor's career.

Look more interesting special conditions work permit defined in the standard. Except passing medical examinations and no restrictions on classes professional activity they include a certificate of a specialist in the specialty "Therapy" and (or) a certificate of accreditation of a specialist in the specialty "General Medicine".

We cannot agree with the proposed edition of the conditions for admission to work.. And that's why.

Certificate of accreditation in the specialty "Medicine" will be only for graduates of medical universities with primary accreditation and without postgraduate education. However, this is only one of the categories of persons who can hold the position of a general practitioner (as we have already indicated above, it is advisable to separate this position from the position of a district general practitioner, as requiring less qualification).

As for doctors with internship/residency training in Therapy, they may have a specialist certificate in Therapy or a certificate of accreditation of a specialist in Therapy. We pay attention to that the current edition of the professional standard does not provide for admission to work with an accreditation certificate in the specialty "Therapy". The occupational standard mentions a certificate in Therapy, but not an accreditation certificate.

Professional standard also completely ignores the conditions for admission to work with training in internship / residency in the specialty "General Medical Practice (Family Medicine)"(The work of doctors of this specialty as a district general practitioner is provided for by order of the Ministry of Health of Russia dated 08.10.2015 No. 707n). Such doctors, in accordance with the requirements of Art. 69, 100 of the Federal Law of November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in the Russian Federation, must have a certificate of a specialist in the specialty "General Medical Practice (Family Medicine)" or a certificate of accreditation of a specialist in the specialty "General Medical Practice (Family Medicine)".

From other characteristics the labor function of a general practitioner in the professional standard is highlighted:

• observance of medical secrecy;
• observance of the Physician's Oath;
• compliance with the principles of medical ethics and deontology in working with patients (legal representatives of patients), colleagues;
• knowledge of legislation in the field of health care, regulatory legal acts and other documents that determine the activities of medical organizations and medical workers, programs of state guarantees, compulsory medical insurance, labor legislation of the Russian Federation;
• professional development of a specialist (including additional professional education).

These characteristics, according to the Faculty of Medical Law, also need some adjustment. So, for example, it is not entirely clear why the observance of medical secrecy had to be singled out separately, if such observance is provided for by federal law, the Physician's Oath and the principles of medical ethics, the need to comply with which is indicated below.

Also, based on the wording of the professional standard, the general practitioner must comply with the principles of medical ethics and deontology exclusively with patients, their legal representatives and colleagues. Thus, if the norms of the standard are read literally, the doctor may not comply with ethical principles with relatives of patients, specialists in related professions, etc. In our opinion, in the professional standard it is necessary not to limit the observance of the principles of medical ethics and deontology to a certain circle of people - the doctor must observe these principles in relation to any person.

Questions are also raised by the inclusion in the professional standard of knowledge of legislation in the field of health protection, state guarantee programs, compulsory medical insurance, and even labor legislation of the Russian Federation. The Faculty of Medical Law has always advocated improving the legal literacy of medical professionals and emphasized the need to educate physicians in the basics of medical law.

However, in Federal State Educational Standard of Higher Education in the field of study 31.05.01 General Medicine (specialist level), approved by order of the Ministry of Education and Science of Russia dated February 9, 2016 No. 95 there are no competencies related to knowledge of medical, and even more so - insurance and labor legislation. In practice, also in most cases, in the process of studying in the direction of "Medicine", students get acquainted only with the basics of jurisprudence (albeit taking into account medical specifics). Similarly, the case is with a specialist in the specialty "Pediatrics".

Obviously, the authors of the professional standard were guided by the Section “Qualification characteristics of positions of workers in the field of health care” of the Unified Qualification Guide for the Positions of Managers, Specialists and Employees, approved by Order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 No. 541n. Indeed, in accordance with it, the therapist must know the legislation of the Russian Federation in the field of healthcare, medical education and regulation labor relations. However, it remains unclear exactly how the general practitioner will acquire this knowledge if it is not provided for in the educational standards. According to the Faculty of Medical Law, it is necessary to ensure the consistency of the professional standard and the Federal State Educational Standard in terms of training future doctors in medical law. The best way to ensure such compliance would be to amend the Federal State Educational Standard with subsequent adjustment curricula and plans (the inclusion in them of the discipline "Medical Law", which provides for the study of legislation, knowledge of which is provided for by the professional standard).

As for the professional training of specialists, we continue to adhere to the opinion (which was detailed in the article "") that professional education medical workers (including advanced training) should be included in the Education and Training Requirements section, and not in the Other Characteristics section.

To the labor functions of a general practitioner, the professional standard includes:

• provision of medical care to the patient in urgent or emergency forms;
• examination of the patient in order to establish a diagnosis;
• prescribing treatment and monitoring its effectiveness and safety;
• implementation and control of the effectiveness of medical rehabilitation of the patient, including the implementation individual programs rehabilitation or habilitation of disabled people, assessment of the patient's ability to work;
• carrying out and monitoring the effectiveness of measures to prevent and promote a healthy lifestyle and sanitary and hygienic education of the population
• maintaining medical records and organizing the activities of the nursing staff at the disposal.

For each of these functions, the professional standard provides for labor actions, the necessary skills and the necessary knowledge. Unfortunately, the volume of this article does not allow a detailed analysis of each of them. Nevertheless, it can be argued that the wording that is contained in the description of composite labor actions, the necessary skills and necessary knowledge in some cases needs to be clarified or changed. Let's give some examples.

For several functions, a complete physical examination of the patient (examination, palpation, percussion, auscultation) is envisaged as a necessary skill of the general practitioner. At the same time, laboratory and instrumental studies, in accordance with the description of the necessary skills and labor actions, are not carried out by the doctor: his actions are limited to determining the scope and drawing up a plan for laboratory / instrumental studies and referral to such studies. In practice, the district therapist independently conducts a number of simple instrumental studies - such as anthropometry, thermometry, tonometry, pharyngoscopy, etc. However, this is not reflected in the professional standard.

Also, the professional standard does not reflect one of the most important, in our opinion, functions of a general practitioner - prescribing medications. The Faculty of Medical Law draws attention to the fact that, in accordance with the Procedure for Prescribing and Prescribing Medicinal Products, approved by Order of the Ministry of Health of Russia No. 1175n dated December 20, 2012, “prescribing” and “prescribing are not synonymous (a number of norms of the mentioned order relate exclusively to prescribing, while time like a number of others - exclusively appointments). Based on the norms of the professional standard, the doctor-physician can only prescribe drugs, but not write prescriptions for them.

From a legal point of view, it is incorrect to attribute the assessment of the effectiveness and safety of the use of drugs to the labor actions of a district doctor. Of course, in accordance with Part 2 of Article 73 of the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”, medical worker must notify the authorized federal agency executive branch on side effects, adverse reactions, serious adverse reactions, unexpected adverse reactions when using drugs, individual intolerance, lack of effectiveness of drugs, as well as other facts and circumstances that pose a threat to life or health of a person or animal when using drugs and identified at all stages of drug circulation in the Russian Federation and other countries. However, the evaluation of the efficacy and safety of the use of drugs belongs to pharmacovigilance. In particular, the preparation of reports on the safety of a medicinal product for medical use(hereinafter referred to as the Periodic Report), containing information on the safety of a particular medicinal product, which contain a reasonable assessment of the expected benefits and possible risks of use, is within the competence of Roszdravnadzor, and not individual general practitioners. In view of the above this function The physician-physician is better formulated as "monitoring the safety and effectiveness of the treatment."

You should also pay attention to the fact that the occupational standard entrusts the district therapist with such labor actions as “organization and conduct medical examinations taking into account age, state of health, profession in accordance with the current regulatory legal acts and other documents. Imposing the obligation to organize medical examinations on a doctor does not correspond article 212 of the Labor Code of the Russian Federation, which establishes the obligation of the employer to organize the conduct at the expense of own funds mandatory preliminary (when applying for a job) and periodic (during employment) medical examinations, other mandatory medical examinations, mandatory psychiatric examinations of employees, extraordinary medical examinations, mandatory psychiatric examinations of employees at their request in accordance with medical recommendations. Taking into account the above norms of labor legislation, it is advisable to formulate the labor actions of a doctor in the professional standard as " assistance in organizing and directly conducting medical examinations».

The shortcomings associated with the description of the labor functions of a general practitioner are not limited solely to the above - only the most striking examples are given. In our opinion, the labor functions of a district therapist must be brought into full compliance with the existing legal framework governing his professional rights and obligations (including the regulation on the organization of activities, procedures and standards for the provision of medical care, etc.). So, as an example, we can cite the Regulation on the organization of the activities of a district general practitioner, approved by order of the Ministry of Health of the Russian Federation dated December 7, 2005 No. 765. According to paragraph 6 of this Regulation, the district general practitioner forms a medical (therapeutic) district from the population attached to it , but this function is not mentioned in the professional standard. In the same paragraph of the Regulations, the general practitioner is entrusted with the obligation to organize and conduct health schools, which again is absent in the professional standard. We believe that there is a need to harmonize the norms of the professional standard with other legal acts in the field of medicine - by making changes either to the professional standard or to regulatory legal acts that do not correspond to it.

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Forms a medical site from the attached contingent;

Provides sanitary and hygienic education; advises family members on the formation of a healthy lifestyle;

Carries out preventive work aimed at identifying early and latent forms of diseases, socially significant diseases and risk factors through medical examination of the attached contingent in the prescribed manner, including children, the disabled, people of older age groups;

Refers patients for consultations to specialists for inpatient and rehabilitation treatment for medical reasons;

Organizes and conducts treatment of patients on an outpatient basis, a day hospital and a hospital at home;

Carries out patronage of pregnant women and young children, including newborns, in the prescribed manner;

Organizes and conducts anti-epidemic measures and immunoprophylaxis in the prescribed manner;

Issues a conclusion on the need to refer patients for medical reasons for sanatorium treatment;

Interacts with medical organizations of the state, municipal and private healthcare systems, medical insurance companies, other organizations;

Has the right to monitor the patient at all stages of medical care;

Organizes, together with the social protection authorities, medical and social assistance to the family for socially unprotected groups of the population: the lonely, the elderly, the disabled, the chronically ill who need care;

Manages the activities of medical personnel providing primary health care on the basis of general medical practice (family medicine);

Keeps records and submits reports in the prescribed manner.

The creation of general medical practices is carried out on the basis of the current system of primary medical care. In polyclinics and outpatient clinics for adults, it is necessary to gradually introduce general medical practice, financed from the municipal budget, instead of district therapists. The organization of the work of primary health care on the principle of a general practitioner in the countryside is especially in demand.

In urban areas, it is preferable to organize group general medical practices, in some cases, especially in remote microdistricts, individual general medical practices should be organized as additional structures to the existing outpatient network. It is advisable to include in the centers of general medical practice social worker, psychologist, etc.

The experience of general practitioners shows that they take on more than a third of visits to specialist doctors, respectively, reducing the number of referrals for consultations and increasing patient satisfaction in certain types specialized help.

In the context of the introduction of general medical practice (family medicine), it is necessary to activate and change the role of the nurse. As a direct assistant to the GP (family doctor) in the prevention, rehabilitation and treatment of family members, the nurse at the same time performs a great independent work. Main place of business nurse occupies patronage work, main goal which is the fulfillment of doctor's prescriptions, monitoring of priority families, identification of families with social and hygienic problems, timely informing the doctor. Patronage visits, door-to-door rounds, personal communication with residents of the site, family members and in the family circle is a practice-proven form of work organization, which should form the basis of the work of a general practice nurse.

Patronage work is carried out with the participation of a doctor - this is the advantage of a family doctor's nurse over a paramedic and midwife in countryside. The feldsher and midwife of FAPs, due to their remoteness from the rural district hospital, do not have the possibility of daily contact with the doctor. The general practice nurse of the city polyclinic has the opportunity to receive advice from the doctor as needed and sometimes do independent examinations. At the same time, she performs all the manipulations necessary in an outpatient or outpatient setting - injections, measurement of blood pressure, temperature, pulse, cupping, etc.

During a patronage visit, the nurse observes the patient, finds out the state of health of family members, checks the correctness of the recommended treatment and regimen. If, when visiting a family, a nurse reveals a deterioration in the health of patients and a systematic failure to follow the recommendations of the family, then she takes appropriate measures, invites patients to a general practitioner or visits the family with a doctor. Patronage visits are used for sanitary and educational work in families, improving the sanitary culture and sanitary literacy of the population.

The results of patronage work are discussed with the doctor. The doctor looks through the records of the nurse, analyzes the results of the work and gives his instructions. Thus, all preventive work at the site can be effectively carried out only through patronage visits, and the nurse should be considered on an equal footing with the GP (family doctor) - a guide to prevention.

The division of the entire volume of patronage work by type of activity makes it possible to single out three main areas:

Medical work by fulfilling the appointments of GPs at home;

Preventive work aimed at preserving and maintaining health and preventing diseases of both chronically ill people, persons from risk groups who are under dispensary observation, and practically healthy patients;

Sanitary and educational work, differentiated according to the needs of the family.

This requires the nurse to have in-depth knowledge of the family, disease prevention, patient psychology, knowledge ethical standards family work. And always an indispensable assistant in the work of a nurse with a family should be a friendly, optimistic tone of relationships, without excessive formality in relationships. At the same time, excessive familiarity, extreme politeness and sensitivity, a high culture of communication are not allowed - the main requirements for establishing mutual contacts. Unlike a doctor, a nurse has more time for a detailed acquaintance with the patient's condition, the conditions of his life in the family, the peculiarities of family relationships, the patient's attitude to the disease, which forms the basis for fulfilling medical prescriptions.

The field of activity of a general practice sister is becoming much wider than the functional duties of just a local therapeutic nurse. She, working in a team with a general practitioner, should be sufficiently oriented in the main related specialties, able to provide multidisciplinary outpatient care for the most common diseases and emergency conditions, should synthesize both preventive, social, and therapeutic, and sometimes psychological care.

The polyclinic, gradually transforming into diagnostic and consultative centers, concentrates in its composition specialized advisory, diagnostic, preventive and health care, which allows you to move from specialized inpatient care to specialized outpatient care. The provision of consultative and diagnostic assistance in polyclinics is possible only with the modernization of the existing diagnostic and treatment equipment.

Care services, medical and social assistance centers, day hospitals and outpatient surgery centers, a home hospital, departments and rehabilitation treatment centers are developing in the structure of polyclinics.

In order to free the ambulance service from functions that are unusual for it (60% of all calls are requests for exacerbation of chronic diseases), the functions of emergency care should be transferred to the outpatient department and general medical practices by creating departments, emergency rooms in municipal medical and preventive institutions.