Training move welcomed, but where’s the detail?

The decision to hand GP training back to the colleges is welcomed, but registrars are concerned about the lack of detail and consultation

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Health Minister Greg Hunt’s announcement that GP training will be handed to the RACGP and ACRRM from 2019 has delighted the two colleges but left GP registrars concerned about the lack of detail and consultation.

Mr Hunt revealed the plan for a three-year transition to college control in a surprise move at the RACGP’s annual conference last week, but he offered no details about what the future might hold for program funding or the fate of the nine regional training organisations currently in charge of training delivery.

The two colleges will take over from Australian General Practice Training (AGPT), a government entity that absorbed the $220 million GPET program after it was axed as a cost-cutting measure in 2014. The profession will thus regain control of GP training after a hiatus of 15 years.

RACGP President Dr Bastian Seidel said securing the delivery of the AGPT program was an “exceptional outcome” for the profession, after the colleges this year were given control of the selection of GP training candidates.

He said the transition to a profession-led training program was consistent with other specialist medical colleges.

“Complete RACGP control of selection will improve completion rates and lessen the costs associated with remediation and withdrawal,” he said.

Dr David Campbell, ACRRM’s national censor in chief, said the rural-oriented college was well equipped for the role since it already ran an AMC-accredited, independent training pathway and had developed accredited training posts across the country.

“We are about training doctors with generalist capabilities to deliver services to rural communities across the board, in hospitals, community care and remote settings,” he said.

“Our curriculum is designed to enable that level of care across all of those settings, so we are in a good position to take over this training in the next three to four years.”

The long-awaited decision coincides with the appointment of Australia’s first national Rural Health Commissioner and would help ACRRM fully align workforce training to match medical workforce needs.

“Clearly that is a major opportunity for ACRRM, because that’s what we are about,” Dr Campbell said.

He said ACRRM would seek more flexibility in training requirements for registrars than under AGPT.

But issues such as funding, what relationships the colleges will have with existing RTOs, and whether those RTOs will survive the restructuring, were “crystal-ball gazing” at this stage, he said.

“The other potential model, of course, is for the purchase-of-provider model where the colleges purchase training on behalf of our registrars and trainees from RTOs, from hospitals, from practices, et cetera,” Dr Campbell added.

“We haven’t seen any detail of the government’s plans, and I suspect there hasn’t been much thought put into the detail of the transition other than the endpoint that the minister would like to arrive at.”

Dr Melanie Smith, President of the General Practice Registrars Association, agreed the shake-up could bring an opportunity to address workforce distribution problems – along with better terms and conditions for GP registrars.

She was disappointed that registrars had not been consulted on the change.

“Certainly it seems appropriate that training should be run by the colleges.  But registrars need to be heard in the process, and registrars’ interests need to be considered, and so far they haven’t.

“We’ve not heard anything from the minister, which is disappointing,” she told The Medical Republic.

Dr Smith said GP registrars had shown a strong interest in training and working in underserved communities, but were deterred by bureaucratic inflexibilities.

“At the moment, there are all sorts of requirements and inflexibilities around the training program which actually don’t serve registrars very well who may want to develop specific skills to serve local communities.   This is a real chance to change that,” she said.

“It could be great for registrars.  It hopefully it could address problems we’ve seen with changes to policy in AGPT that have come through from the Department of Health.”

GP registrars moving out of state hospital systems into general practice, with individually negotiated contracts, also faced a huge cut in pay and conditions compared to other specialist trainees on state-based awards, she said.

“It makes it a far less attractive specialty, when you don’t feel valued.”

Dr Smith said GPRA would keep the door open to ACRRM registrars, despite their move to seek a separate, independent voice.  Historically, only about 5% of GPRA’s membership have been trainees or students affiliated with the smaller college.

The ACRRM registrars committee has recommended ACRRM stop sending two representatives to GPRA advisory committee meetings twice a year.  A decision is expected next month.

“We will continue to represent them. The invitation will always be open, we will still try to maintain contact and communication,”  Dr Smith said.

Beginning with the 2018 intake of 1500 GP registrars, the RACGP is responsible for choosing 1350 and ACRRM has been allocated 150.