New training pathway for GPs

From this month, GP training officially moves back into the fold of Australia’s specialist medical colleges – the Royal Australia College of GPs and the Australian College of Rural and Remote Medicine.

They are now responsible for the Australian General Practice Training program, which trains medical registrars to enable them to work as GPs anywhere in Australia.

The program is three to four years of full-time training offered in metropolitan, rural, remote and very remote locations nationally.

RACGP and ACRRM will deliver AGPT program training through their respective college-led training models and have set up a company – Joint Colleges Training Services – to oversee the programs.

The move back to college-led training brings general practice into line with other medical specialist training programs across Australia.

Medical Forum asked RACGP president Dr Nicole Higgins what the new training pathway means for general practice.

MF: From 2023, the AGPT program in WA will be run by RACGP and ACRRM. What is the significance of training returning to the colleges?

NH: The return of GP training to the RACGP and ACRRM is an important opportunity for the profession to build on what works and deliver world class training, so future GPs are equipped to meet the challenges of 21st century patient care. Bringing the delivery of the training program back to the colleges brings general practice into line with every other medical discipline nationally.

MF: What will be the impact, if any, on the training for future generations of GPs?

NH: Our priority is ensuring a smooth transition for GPs in training, and their supervisors. 

We have designed our delivery operating model, building on and respectful of existing approaches that will minimise disruption throughout the transition. 

The colleges will continue to build on the successes of the previous custodians of the Australian General Practice Training Program.

The local names and faces in our delivery teams are largely recruited from regional training organisations. They know the geography, the local culture and importantly the registrars, supervisors and training practice staff. They will be central to the program’s success. 

State and territory regional leadership and support teams will support these local teams. 

Our national leadership teams and support services will provide national consistency to support systems that enable local delivery. 

Each regional and local team will have the opportunity to implement regional responses to training delivery that best meets the needs of their communities.

MF: Can you explain the role of the newly formed company, Joint Colleges Training Services?

NH: Our joint venture with the Australian College of Rural and Remote Medicine, Joint Colleges Training Services Pty Ltd (the Company), will oversee joint AGPT training program services.

The company will initially support AGPT activities, including:

  • the development and delivery of Aboriginal and Torres Strait Islander health strategic plans, including cultural education and cultural mentorship;
  • the provision of registrar housing in remote Northern Territory;
  • other potential areas of collaboration to be agreed between ACRRM and the RACGP.

The company will initially adopt the current strategic plans developed by each RTO and then look to develop an integrated, nationally consistent but locally-produced and delivered strategic plan in 2023.

MF: Does GP training need to be more flexible and adaptive to reflect the changing world and the work-life balance?

NH: GP training is an extension of general practice as a profession. General practice has proven just how flexible it can be. It adapted to not just meet, but lead the needs of new world problems like the COVID-19 pandemic responses in Australia over the past two years. 

The Australian Government of course play a significant role in enabling the profession’s agility. Telehealth for example would not have been possible without Government support to enable this change to MBS item numbers, which in turn allowed GPs to deliver and bill for consultations online. 

We look forward to seeing Australian Government support to continue to enable general practice evolve to meet the needs of our communities as they change.

MF: General practice is facing some major challenges in terms of morale and the Medicare funding model. How is the RACGP approaching the direct responsibility of training the new generation of GPs in the current climate?

NH: As Australia’s largest representative body for GPs, and the next custodians of GP training, our role is also to be strong advocates for GPs, including those in training.

We understand the challenges facing GPs today due to successive governments taking funding from general practice, while at the same time community demand for GP care has increased exponentially due to the impacts of the COVID-19 pandemic, as well as rising rates of chronic conditions, mental health issues, and our ageing population.

Our commitment to our members is that we will continue to advocate for the changes they want and need, to safeguard general practice for the future, and ensure everyone across Australia can access high-quality care regardless of their postcode. We know from our latest Health of the Nation report, that funding, work-life balance and wellbeing are of primary concern, particularly due to the growing administrative burden and opaque Medicare rules.

While there are significant challenges, the launch of Australia’s first Parliamentary Friends of General Practice is a significant step towards the voice of general practice being heard loud and clear in parliament. 

MF: What changes or improvements will be made to this training journey, particularly for rural generalists’ training?

NH: It’s important to acknowledge that GP training isn’t broken. The Australian GP Training program delivers and maintains world-class primary care. 

The transition represents significant change in and of itself. We will ensure continuity in delivery of the program first, taking particular care to ensure our registrars, supervisors and practices are disrupted as little as possible and then look to further opportunities in 2024 and beyond. 

MF: What do you see as the role of the WA Primary Health Alliance (WAPHA) in GP training?

NH: WAPHA is one of many Workforce Prioritisation and Planning Organisations charged with mapping supply of the registrar and GP workforce and the corresponding patient demand which will help inform GP training priority areas in 2024 and beyond. WAPHA as a key stakeholder is one of many organisations that will have a voice to inform the college’s approach to GP training via regional advisory councils.

MF: What do governments in general need to do better to support general practice in Australia?

NH: We are continuing to call for more support and funding for patients to access high-quality care through general practice.

The current model of health-care funding in our country is extremely lopsided – more Australians visit a GP every year than any other service in our entire health system, but funding for general practice patients is less than 8% of total government health spending. We are seeing more and more GPs moving away from bulk billing as Medicare rebates are set nowhere near the level needed to cover rising practice costs. Concerningly, the number of medical students choosing general practice as their preferred specialty is also at an all-time low of 13.8%. 

The evidence shows that if we invest more in preventative care for Australians, and measures to keep people well in the community supported by their GP, we will have a healthier population, higher productivity, and lower spending on expensive hospital care. And the RACGP will continue to advocate strongly for this to happen via reforms aligning with our vision for general practice and a sustainable health-care system.  

The RACGP has been calling for the Federal Government to implement reforms in the short term to improve patient health outcomes, including:

  • enhanced primary care services for people over the age of 65, people with mental health conditions and people with disability
  • longer general practice consultations to support patients with complex needs
  • improved access to telehealth
  • support for patients to see their GP within seven days of an unplanned hospital admission
  • improved access to care in rural communities, by encouraging and supporting rural doctors to upskill.