The Future of General Practice Training – An Overview

Simon Willcock

1. The Future of General Practice?

2. Do we need Postgraduate Training for General Practice?

3. Learning from the Past – Lessons from GP Training In Australia 1975 to 2015

4. Current Issues for General Practice Training

5. ? Solutions

Evidence of the health-promoting influence of primary care has been accumulating… and shows that primary care helps prevent illness and death (more so than specialist care) and is associated with a more equitable distribution of health in populations

BARBARA STARFIELD, LEIYU SHI, and JAMES MACINKO - 2005

The Future of General Practice ?

About 75 percent of visits to a pulmonary specialty clinic were just for “checkups,” even though the patients’ primary care physicians, once they had access to the specialists’ reports, could just as easily perform this function and report the findings to the specialists.

(From Hewlet et al)

BARBARA STARFIELD, LEIYU SHI,and JAMES MACINKO - 2005

Summary:

From economic, equity and outcome perspectives we need a robust primary health care system in Australia…

… that articulates with an appropriately accessed specialist consultant system

1. The Future of General Practice

…or are you just a GP?

The perception of General(ist) practitioners has varied from a “cornerstone of the health system” (Osler) …

2. Do we need Postgraduate Training for General Practice?

… to a redundant/default option (? Precipitated by the Flexnerian organ systems based approach to medical education along with exponential increases in knowledge)…

… and back to “cornerstone” status in recognition of the unique set of skills needed by the generalist

(Patient centred care and the “digital revolution” have facilitated this)

Pre 1975 – no prescribed formal training, (but a wide scope of potential experience prior to independent practice).

1975 – 2000 – Family Medicine Program, and RACGP TP – characterised by progressively less flexibility in training and a progressively more dense and prescribed curriculum

~2000 “crisis” with RACGP losing control of the TP and establishment of GPET and RTPs.

40 years of Australian GP Training

2002 – 2014 – GPET/RTP model (External administration while RACGP and ACCRM maintain control of “standards” and assessment

2015 – announcement of a new Training Region Model – details still

unclear

(Can we see the wood for the trees?)

40 years of Australian GP Training

AGPT RecruitmentFigure 1: Applicants and training places by intake year

AGPT Recruitment

Figure 2: Applicants to AGPT by graduate status and intake year

AGPT RecruitmentFigure 3: Proportion of recent AMG (post-graduate year 1 to 5) applying for AGPT

Workforce Figure 7: Relative contribution of AGPT to GP workforce by RA

Training CapacityFigure 13: Registrars and accredited facilities and trainers by training year

1. Seeing the wood for the trees!!

The previous systems have been of a high standard, but…

- expensive in terms of the total cost per trainee

- administratively cumbersome ? reasons for this

- overly prescriptive and lacking in flexibility (both Colleges have contributed)

Current Issues for Australian General Practice Training

2. Inconsistency in the training pipeline

- variable (and overall poor) support and funding for community based training at an undergraduate level

- the bizarre and illogical decision to discontinue funding for prevocational terms in general practice (? a casualty of federal/state bickering)

- insufficient increase in local medical graduate numbers in GP training

Current Issues for Australian General Practice Training

Health Workforce 2025 - Medical

Australia’s Health Workforce 2025 – HWA, 2012

3. Failure to support a sustainable General Practice sector by the Commonwealth,

leading to…- trainee recruitment problems- supervisor engagement problems

Current Issues for Australian General Practice Training

1. Back to Basics in terms of training principles(Patient centred care and continuity of

care)

2. Consistent messages and support from the Commonwealth (consistency is more important than quantum)

3. More equitable relationships between the Primary Care sector and State and Territory health departments

? Solutions

Supporting trainees (to become mature independent practitioners)

Flexible curriculum (focussing on general practice skills rather than discrete knowledge)

Flexible training environments Minimal administrative bureaucracy Supporting supervisors

What are the Basics for training?

Academic and Community Medical Centers50% of concerns associated with 9-14% of Physicians

30 35 40 45 50 55 60 65 70 75 80 85 90 951000

25

50

75

100Academic Med CtrCommunity Med Ctr

% of Physicians

% o

f Con

cern

s

Note: 35-50% are associated with NO concerns

Hickson GB, et al. So Med J. 2007;100:791-6; Hickson GB, et al. JAMA. 2002 Jun 12;287(22):2951-7.22

Can we do it?

It is Bismarck who reputedly observed that those who love sausages or laws or both should not watch them being made.

He could have said much the same about health policy, certainly the health policy on the table at this election

Professor Stephen Leeder (Director of the Menzies centre for health Policy) - SMH - August 19, 2010

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Can we do it?

Yes we can!

Thank you…Have fun…

Make a difference !