Health checks and prevention in Australian general practice

Prevention in Australian general practice — why the framework matters

Prevention is not a single conversation — it is a layered system of age-appropriate checks, population-level screening programs, immunisation schedules, lifestyle interventions, and chronic disease management plans, all coordinated through the general practice relationship. Australian general practice is uniquely positioned to deliver these: a trusted, accessible, long-term relationship with continuity.

The RACGP Red Book (Guidelines for Preventive Activities in General Practice, 10th edition) is the authoritative Australian reference for preventive activities, setting out recommendations by age, risk, and condition. The Australian Bureau of Statistics consistently shows that people with a regular GP are more likely to receive preventive care — including cancer screening, vaccination, and lifestyle advice — than those without.

This article organises the main preventive activities by age and type. It is a companion to individual condition pages for hypertension, diabetes, smoking cessation, mental health, and immunisation — each of which covers the evidence and clinical management in detail.

A. Core clinical — the AU general-practice framework

Preventive activities by age group

Under 15 — children and adolescents

The foundation of childhood prevention is the National Immunisation Program (NIP), delivered per the Australian Immunisation Handbook. The schedule includes: diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenzae type b, pneumococcal, rotavirus, varicella, MMR, MenACWY, and MenB (selected groups).

The Healthy Kids Check (MBS items 709–712) at age 4 covers developmental screening, vision, hearing, growth, dental health, and oral hygiene. Child health nurses provide universal contacts through state and territory services in the early years.

HPV vaccine is offered as a school-based programme at age 12–13 (single dose since 2023 for most age groups). Meningococcal ACWY booster is provided at 14–16 years through school programmes.

Age 15–24 — young adults

The HEEADSSS psychosocial assessment is the key consultation framework for adolescents, covering Home, Education/Employment, Eating, Activities, Drugs/Alcohol/Cigarettes, Sexuality, Suicide/Depression/Self-harm, and Safety. It should be used at every relevant consultation.

Preventive priorities include: mental health screen (K10, PHQ-9, EPDS in pregnancy); STI screening if sexually active (chlamydia, gonorrhoea, syphilis, HIV); alcohol and drug brief intervention using the 5As; and HPV catch-up vaccination for those not yet immunised (available through GPs to age 25). Cervical screening begins at age 25.

Age 25–44 — early and mid-adulthood

Cervical screening with HPV testing every 5 years from age 25 is the key addition in this age group. Self-collection is universally available from 2022 — an important equity improvement reducing barriers for those who have previously declined speculum examination.

Cardiovascular risk assessment applies from age 35 in people with type 1 or type 2 diabetes, and from age 30 for Aboriginal and Torres Strait Islander patients. For everyone else, formal risk calculation begins at age 45.

Pregnancy planning deserves specific attention: folic acid 500 mcg (5 mg if high-risk — prior neural tube defect, antiepileptic medication, BMI ≥30), iodine supplementation, vaccination review (rubella, varicella, dTpa, influenza, COVID-19), and optimisation of metabolic and chronic conditions before conception.

Age 45–49 — the health assessment window

The 45–49 health assessment (MBS items 701–707, varying by consultation length) is one of the highest-yield preventive activities in Australian general practice. It encompasses:

• Cardiovascular risk calculation using the 2023 Australian CVD Risk Calculator from the Heart Foundation
• Heart Health Check (MBS item 699) — available annually for adults ≥30 (≥18 for ATSI patients) — addresses lipids, blood pressure, smoking, diabetes, and CV risk in one structured review
• Type 2 diabetes screen — HbA1c, fasting plasma glucose
• Bowel cancer screening — NBCSP iFOBT, now available from age 45 (expanded 1 July 2024)
• Fasting lipid profile
• Mental health screen — K10 or PHQ-9
• 5As lifestyle intervention for smoking, alcohol, weight, physical activity, and diet
• Vaccination review — annual influenza, COVID-19 per ATAGI, dTpa booster

This age window is strategically important: many conditions that substantially drive disability and mortality in later life (cardiovascular disease, type 2 diabetes, CKD, depression) can be identified at a pre-symptomatic or early stage here.

Age 50–74 — cancer screening intensifies

The national cancer screening programmes intensify in this age group:

• Bowel cancer: NBCSP iFOBT every 2 years for ages 45–74 (note the 2024 age-expansion to 45)
• Breast cancer: BreastScreen Australia mammogram every 2 years, targeted invitation for ages 50–74; ages 40–49 and 75+ may participate but are not actively invited
• Cervical cancer: NCSP HPV 5-yearly continues to age 74; self-collection option available
• Lung cancer: The Australian Lung Cancer Screening Program began implementation in 2025 — annual low-dose CT for high-risk current or former smokers aged 50–70 with ≥30 pack-year history who have smoked within the last 15 years

Prostate cancer screening (PSA): Not a population screening program in Australia. RACGP, USANZ, and Cancer Council Australia recommend shared decision-making — discussing benefits (early detection opportunity) and harms (over-diagnosis, over-treatment, PSA imperfections) before any testing. Initiate this conversation at age 50 (45 for those with a first-degree family history; 40 for those with multiple affected relatives or known BRCA2 variants).

Skin cancer: No population-level screening program exists, but annual or biennial full-skin examination is appropriate for high-risk individuals (fair skin, personal or family history of melanoma, history of significant sun exposure, immunosuppression). MBS item 104 applies to thorough skin examinations in appropriate clinical contexts.

Vaccination priorities extend in this age group — annual influenza (free ≥65), Shingrix zoster (2 doses, free ≥65), Prevenar 20 pneumococcal (one dose, free ≥70), RSV vaccines (free ≥75 from 2025 under the NIP), and COVID-19 boosters per ATAGI risk-stratified guidance.

Age 75 and over — the comprehensive assessment

The 75+ Health Assessment (MBS item 705, annually) is a structured comprehensive review specifically designed for older adults. It encompasses:

• Cognitive screen — MoCA (preferred over MMSE); RUDAS or KICA in culturally appropriate contexts; KICA for Aboriginal and Torres Strait Islander patients
• Falls risk — Timed Up and Go (TUG), gait assessment, balance, sensory assessment; home environment review
• Continence — urinary and faecal, assessed and managed
• Social circumstances — support network, isolation, financial security, and screening for elder abuse and neglect
• Vision and hearing — referral to optometrist or audiologist where indicated
• Mood — Geriatric Depression Scale (GDS-15), PHQ-9; depression under-recognised in this group
• Activities of daily living (ADL) and instrumental ADL
• Polypharmacy review — STOPP/START criteria; medication burden; high-risk medicines (hypnotics, antipsychotics, NSAIDs, sedating antihistamines); HMR referral for complex cases
• Nutritional status — Mini Nutritional Assessment (MNA); weight trajectory; appetite
• Vaccination update
• Advance care planning — while capacity is intact; EPOA (Enduring Power of Attorney), Advance Care Directive; referral to My Aged Care for Home Care Package assessment if functional needs present

B. Chronic disease management — GPCCMP and allied health access

The GPCCMP transition (1 July 2025)

From 1 July 2025, the GP Chronic Condition Management Plan (GPCCMP) replaced the former GPMP (item 721), Team Care Arrangements (TCA, item 723), and associated review item (732). This applies to patients with complex or chronic conditions expected to last 6 or more months with patient consent.

MBS items:

• 965 — preparation (face-to-face GP consultation)
• 967 — review (face-to-face)
• 92029 / 92030 — video telehealth equivalents
• 92060 / 92061 — telephone equivalents

Per Services Australia GPCCMP guidance, the GPCCMP enables 5 allied health sessions per year (10 for Aboriginal and Torres Strait Islander patients) covering physiotherapy, occupational therapy, dietetics, exercise physiology, psychology, podiatry, speech pathology, audiology, and others depending on clinical need.

Review every 3 months is recommended for active management; mandatory review at 18 months is required for ongoing allied health access to continue.

Old GPMP and TCA plans prepared before 1 July 2025 remain valid until 30 June 2027, but new plans from July 2025 onward must use the GPCCMP structure.

Better Access Mental Health Care Plan

The Better Access initiative provides access to subsidised psychology services via GP referral:

• Items 2700/2701 — MHCP preparation by any GP
• Items 2715/2717 — MHCP preparation by a mental-health-trained GP (higher rebate)
• Item 2712 — MHCP review

This enables 10 individual psychology sessions per year (6 initial + 4 additional if GP reviews progress) and 10 group sessions. For eating disorders — anorexia nervosa, bulimia nervosa, binge eating disorder, OSFED — a separate Eating Disorder Plan (items 90250–90263) provides up to 40 individual psychology sessions and 20 dietetics sessions per year.

C. Cancer screening in Australia

Cancer	Test	Frequency	Age range	Program
Bowel	iFOBT	2-yearly	45–74	NBCSP (age expanded to 45 from 1 July 2024)
Breast	Mammogram	2-yearly	50–74 (40+ free but not invited)	BreastScreen Australia
Cervical	HPV test (self-collection option)	5-yearly	25–74	NCSP
Lung	Low-dose CT	Annually (high-risk)	50–70, ≥30 pack-years, quit <15y	Lung Cancer Screening Program from 2025
Prostate	PSA (shared decision-making)	Individualised	Shared decision-making from 50	Not a population screening program
Skin	Clinical skin examination	Periodically (high-risk)	All ages, high-risk groups	No national program

For any patient eligible for a national screening program, GPs should confirm participation status at each health assessment and facilitate access for those overdue.

D. Australian operations — MBS, PBS, and vaccination programs

Key MBS health assessment items (verified via MBS Online)

Assessment	MBS item	Frequency
Healthy Kids Check (age 4)	709	Once at age 4
45–49 Health Assessment (brief)	701	Once per lifetime (age 45–49)
45–49 Health Assessment (standard)	703	Once per lifetime
45–49 / 75+ Health Assessment (long)	705	Annually (75+); once (45–49)
75+ Health Assessment (prolonged)	707	Annually
Heart Health Check	699	Annually, from age ≥30 (≥18 ATSI)
ATSI Health Assessment	715	Every 9 months, any age

Lifestyle programs and PBS — smoking and alcohol

Smoking cessation pharmacotherapy (per eTG):

• NRT (patches, gum, lozenges, inhalator) — PBS scripts; Authority Required for extended courses
• Varenicline (Champix) — PBS Authority Required; most effective pharmacotherapy
• Bupropion — PBS Authority Required
• Quitline 13 7848 — free telephone counselling, highly effective when combined with pharmacotherapy

Alcohol brief intervention — AUDIT-C or full AUDIT at relevant visits; brief intervention for hazardous drinking (5As). Naltrexone and acamprosate are PBS-listed for alcohol use disorder (Authority Required).

Vaccination program — 2024–25 NIP updates

The National Immunisation Program schedule has had significant expansions in 2024–25:

• RSV vaccines (Arexvy / Abrysvo) — free under NIP for adults ≥75 from 2025; Abrysvo free in pregnancy 28–36 weeks (maternal RSV immunisation)
• Shingrix (zoster) — 2-dose schedule, free for adults ≥65 and immunocompromised adults ≥18
• Prevenar 20 (pneumococcal) — one dose free for adults ≥70, replacing the older PCV13 + 23vPPV sequence
• Influenza — annual; free for those ≥65, pregnant women, ATSI people ≥6 months, and those with medical risk conditions
• COVID-19 — ongoing per ATAGI; 6-monthly boosters for those ≥75 and immunocompromised; risk-based for others

Refer to Australian Immunisation Handbook for full current schedule and catch-up calculators.

E. Special populations

Aboriginal and Torres Strait Islander Australians

The ATSI Health Assessment (item 715, every 9 months for any age) is the cornerstone of organised preventive care for Aboriginal and Torres Strait Islander patients. It is more frequent than other health assessments to address the substantial chronic disease burden and earlier disease onset.

Cardiovascular risk calculation applies from age 30 (versus 45 in the general population). Diabetes screening begins earlier. Kidney function (eGFR and UACR) is included at every assessment given the high prevalence of diabetic and hypertensive nephropathy.

The Closing the Gap PBS co-payment program significantly reduces medication costs — voluntary registration through Services Australia. Aboriginal Community Controlled Health Services (ACCHS) provide culturally safe, comprehensive care and are the preferred setting for many communities.

Older adults

The 75+ Health Assessment is the most comprehensive and highest-yield preventive activity for older adults. Key action areas are falls prevention, polypharmacy deprescribing, cognitive screening, continence management, and advance care planning.

Engage My Aged Care assessment for patients who may benefit from Home Care Packages or residential care. Carer burden assessment is appropriate — carers of people with dementia and chronic complex illness are at high risk of depression and burnout.

Refugees and newly arrived Australians

Refugees and people from humanitarian backgrounds often arrive with incomplete vaccination records and may have missed national screening programs. A structured post-arrival health assessment should include: catch-up immunisation (ATAGI Catch-up Calculator), tuberculosis screening, blood-borne virus screen (HIV, hepatitis B and C), intestinal parasite screen, iron studies, and mental health screen. Use TIS National interpreter services (131 450) where needed. State-based refugee health services provide specialised assessment pathways.

Pregnancy

Every pregnancy offers a preventive opportunity. Ensure: dTpa (pertussis) booster in each pregnancy (20–32 weeks), annual influenza vaccination, and Abrysvo RSV vaccine at 28–36 weeks from 2025. Review of cervical screening status, domestic violence screening (DV-Alert framework), and mental health assessment (Edinburgh Postnatal Depression Scale at 6–8 weeks postpartum) are all standard components.

When to escalate

Preventive activities rarely require emergency escalation, but several findings warrant urgent action:

• Positive bowel cancer screening (iFOBT) → urgent gastroenterology or colorectal surgery referral for colonoscopy within recommended timeframes (generally within 30 days)
• Suspicious mammogram or breast lesion → BreastScreen assessment or specialist breast clinic (same-week if high suspicion)
• High-grade cervical dysplasia on HPV screen → colposcopy via NCSP referral pathway
• Lung nodule on screening CT → chest physician or thoracic surgery review (timeframes per lung nodule reporting guidelines)
• Cognitive decline detected on 75+ assessment → neuropsychological testing, specialist (geriatrician or neurologist) review, My Aged Care assessment for support services
• Elder abuse identified → mandatory reporting in most states; consultation with state-specific reporting pathways and social work support

For suicide risk identified on mental health screening: follow the RACGP adult suicide risk assessment framework; safety plan and crisis support numbers (Lifeline 13 11 14, Beyond Blue 1300 22 4636, 13YARN 13 92 76); consider same-day assessment or Emergency Department referral for high acute risk.

What this article is and is not

This is general health information drawn from current Australian general practice guidelines — RACGP Red Book (10th edition), eTG, NHMRC Eat for Health, Heart Foundation 2023 CV risk guideline, and the Australian Immunisation Handbook. It does not constitute personal medical advice and does not create a doctor–patient relationship.

The recommendations in this article apply at the population level; individual circumstances — family history, medications, prior results, comorbidities — affect what is appropriate for any specific person. Discuss your preventive activities with your GP.

For consumer-friendly resources: HealthDirect — Health checks, Cancer screening programs, My Aged Care, National Immunisation Program.

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Sources cited

1. RACGP — Guidelines for preventive activities in general practice (Red Book) 10th edition
2. Heart Foundation — 2023 Australian Guideline for assessing and managing CV risk
3. Australian Immunisation Handbook (ATAGI)
4. National Cancer Screening Programs
5. NBCSP — National Bowel Cancer Screening Program
6. BreastScreen Australia
7. NCSP — National Cervical Screening Program
8. MBS Online — health assessment and GPCCMP items
9. My Aged Care
10. Services Australia — Closing the Gap PBS Co-payment Program
11. Services Australia — GPCCMP billing rules
12. Therapeutic Guidelines (eTG) — Preventive health
13. NHMRC — Eat for Health (Australian Dietary Guidelines)
14. Australian Government — Lung Cancer Screening Program
15. HealthDirect — Health checks