POLICY NEWS DEC 2017
As we wind down to the end of the year, we look at the latest items in terms of policy including revalidation, cloud-based medicine and patient experiences of general practice.
Revalidation – a rose by any other name….
The Medical Board of Australia released its long-awaited response to the Expert Advisory Group on revalidation and their recommendations.
The result is…(drum roll) the Professional Performance Framework.
And all 18 of the recommendations of the Expert Advisory Group were either accepted or accepted in principle.
Not a UK style revalidation system (big breath of relief there). The report notes the progress already made in CPD by colleges and the consistency with the proposals in this framework.
But one not likely to endear itself to those aged 70 years or over who provide clinical care to patients.
That’s a step way back from the profile of those previously identified at risk of poor performance that included being male, over 35 years of age and having prior complaints.
The new system requires peer review and health checks for those aged 70 years and three-yearly subsequently.
It also identifies those at risk of professional isolation and requires them to undertake education on how to identify and manage this risk as well as increasing peer-based CPD.
The PPF also targets those who have had multiple substantiated complaints and will require them to participate in formal peer review.
For everyone else, it’s 50 hrs of CPD with a mix of performance review, outcome measurement and educational activities with CPD to be relevant to scope of practice, based on a personal professional development plan and parked with their “CPD home”. That bit’s new. You’ll need to find yourself a CPD provider (one of the colleges or an alternate provider) and participate in that provider’s program.
And self-directed CPD undertaken outside an accredited CPD program will not be recognized.
Reflective practice also features heavily.
And this will apply to ALL registered medical practitioners.
The other new bit that’s not about revalidation per se but is a welcome step in addressing an age-old problem is that of identifying and managing poor professional behavior in early career doctors. That one’s been hand-balled to the AMC.
None of this is going to happen quickly of course. There will be consultations all the way through to 2020. But some activity on issues such as establishing (or not!) the legal basis of peer review, health checks, data sharing and a revised registration standard will start to be tackled next year.
We will keep you posted!
Read all about it here:
The first document is quite helpful and the one-page “pillars” document is very useful.
I’m not a GP but does that woman have a thyroid condition??? I’m sorry but that is a really scary landing page!!!
For those who were not at GP17, one of the opening plenary speakers was a very hip dude (hey, Jay Parkinson) who has founded a business called Sherpaa – “the world’s first primary care-in-the-cloud practice”.
This is a model of primary care that is…. Interesting. And caused quite a bit of buzz amongst the GPs who attended.
Who knows? It could be the future. Uber, AirBnB, Sherpaa – innovation through technology is taking hold in every sphere.
You be the judge: https://sherpaa.com/
You can also view Jay’s plenary address here: http://gp17.com.au/speakers/jay-parkinson
Ps no interest to declare!
Patient experiences in Australia, 2016-17
This is cause for celebration in GP world!
Scroll past the stuff on waiting times, barriers and after-hours care and reflect in the glow of these stats!
Of those who saw a GP in the last 12 months:
(Men reported slightly higher results on these three factors than women).
These figures were 79%, 82% and 80% respectively for medical specialists (which apparently doesn’t include you, or does it??).
But still, those are great stats!
Brought to you by the ABS who successfully carried out the Postal Survey on Marriage Equality!!!
Marriage equality – now law
Unless you’ve been completely detached from the electronic world, marriage equality is now law in Australia.
And here is the official bill:
That’s it for Policy News for 2017!
RESEARCH NEWS – DECEMBER 2017
In this month’s research news we focus in on power dynamics in supervision (“you don’t know the power of the dark side”…), conflict (queue light saber sound), uncertainty (I think) and on the very big difference you make on your patients’ BP.
Power dynamics in clinical supervision
It’s often named as the reason why registrars don’t talk about what they perceive to be a poor experience of supervision and a whole range of other things.
The power differential in the supervisory relationship is undeniable but as these authors propose, it can be used positively or negatively.
So what are these aspects of power and from whence do they originate? This paper describes a study, again in clinical psychology, where 9 supervisees were interviewed in depth.
The results identified 5 categories.
An important source of power is the supervisor’s advanced knowledge and experience. This seems obvious and was agreed by all participants.
Unrecognised and unacknowledged supervisor errors erode the perception of expert power. These errors might be clinical, ethical or administrative.
Perceived misuses of power evoke self-preservation in supervisees. This is where the trainee can revert to turning off from the supervisory process in order to preserve their self-esteem or prevent further disappointment. So maybe that disengaged registrar’s behavior is trying to tell you something?
Power is shared when the supervisor demonstrates trust in the supervisee’s ability. This demonstration was often in the form of taking a more collaborative approach with the trainee.
Supervisor’s transparency and nurturance reduces the power differential. Ok so the language is a bit psychologically-oriented but the concept is the same. Roughly translated this seems to be getting at supervisors being able to share their own perceived weaknesses and uncertainty with their trainee.
Any of this ringing bells for you? If you’re interested you can read all about it here:
A framework for addressing supervisor-supervisee value conflict
Ever had a conflict with a registrar that was about values?
Well this paper from Clinical Supervisor proposes a framework that just might help.
The framework was developed in clinical psychology for managing value conflicts between psychologists and clients, but the framework itself has been adapted by the authors who think it may be useful in any discipline.
The framework is: Detect-Articulate-Respond (DAR).
Would it work in general practice? You be the judge! Tell us what you think. I’d love to know. Drop me an email!
Dunn R, Callahan JL. A proposed framework for addressing supervisee-supervisor value conflict. Clinical Supervisor, 2017:36(2).
Read all about it here:
I’m not sure about this one…
Fascinating paper in Medical Education on the tolerance of uncertainty among GP registrars.
This is yet another paper emerging from the ReCEnT data collection (the study that keeps on giving!).
Seems there are different phenotypes for it! Wow! I didn’t even know there was a gene for it!! My genetics degree has seriously let me down here!
The two ‘phenotypes’ are those with a high affective response to uncertainty, and those reluctant to disclose uncertainty to patients.
The affective aspects of uncertainty were associated with being: female, less experience in hospital prior to commencing GP training and graduation overseas.
The maladaptive response to uncertainty (i.e. reluctance to disclose) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status and being Australian-trained.
Read it hear, unless you’re unsure…
“About your blood pressure …”
Ever doubted that all that emphasis on communications skills in training is worth it?
Interesting paper in this month’s Medical Teacher encourages you to keep it up if you want to have a positive impact on hypertension outcomes.
This was a RCT conducted in Iran that showed that brief communications skills training for health providers seems to improve patient-provider communications skills AND improve hypertension outcomes in those with uncontrolled BP.
The intervention consisted of attendance at 3 focus group discussions and 2 training workshops. “Too much!” I hear you say but the results are quite impressive with SBP dropping by some 21 points and diastolic by 13.
Read all about it here:
And that’s it for 2017!
If you have any comments to make, suggestions, or even good articles you want to share with your colleagues please let me know at firstname.lastname@example.org
Wishing you all season’s greetings and see you in 2018!
The Australian College of Rural and Remote Medicine (ACRRM) is pleased to present our newest Online Learning Module: the Rural Doctors’ Family and Domestic Violence Education Package.
The module has been developed by rural doctors for rural doctors, drawing on the diverse experience of a national team of clinicians. It aims to strengthen doctors’ capacity to address family violence within their rural and remote practice community. It is based on a series of clinically focused case-based discussions with emphasis on providing best practice responses at both the individual and the community level.
Reflecting the diversity of people who are affected by domestic violence in rural and remote communities, the module was developed by doctors across Australia, from locations such as Cooktown, Nhulunbuy, Alice Springs, Parkes and Port Hedland.
Lead Clinician on the program, Dr Jennifer Delima, is a remote and rural GP based in Alice Springs, with further specialisation in clinical forensic and addiction medicine. She heads the central Australian Sexual Assault and Addiction Studies units.
Dr Delima says “for rural and remote practitioners, the module will help them know how to provide holistic care for individual patients and the whole community. Domestic and family violence has for too long been a hidden phenomenon and a silent experience of grief and trauma.
“It has such an impact on the individuals, the women and the men and the children who are exposed to the violence as well as on the wider community. It models behavior that can begin repetitive cycles of trauma and grief.
“We know that prolonged and persistent trauma experience in a population, in adults and even more so in children, predisposes people to chronic disease such as hypertension, diabetes, and heart disease; it’s a physical response to the mental issue, the mental exhaustion and tension.
“As GPs, we’re treating those symptoms downstream, but it’s imperative to treat the underlying cause and address the issue up stream if we’re ever going to change anything.”
The module is available from acrrm.org.au and is complimentary to all ACRRM members as part of their membership.
“The Silverware returns” was the turn of phrase tweeted by the GP community after The Hon. Minister Greg Hunt’s announcement last week that GP training would return to the auspices of the Colleges. This would then make all vocational training programs nationally profession lead.
Of course, this is a big change, but with a transition period between 2019-2022, like the most recent shake up of the industry, this change should be orderly and the infrastructure that constitutes the “silverware’s” return is unlikely to be trashed by those who need it most – the colleges.
While the announcement came as a shock to some, such propositions have been circling since the last major industry shake up when the dissolution of GPET was announced. The subsequent change, while challenging in some quarters has continued to deliver quality training outcomes and millions of tax payer dollars in savings – most a successful experiment.
This of course is testament to GP supervisors’ orientation to quality and regional training organisation personnel weathering significant GP training system changes – we expect that the same will be true with this latest announcement. That is because the Australian GP training system is far more complex and robust than one decision.
What will be important moving forward is that GP Supervisors remain engaged and despite the challenges ‘change’ presents, to continue to contribute positively to industry fora on the topic.
GP Supervisors Australia will continue to seek the views of the membership as we have been, while also highlighting the challenges and providing sensible and constructive solutions to national GP training policy as it evolves in this regard.
While we recognise that the announcement presents opportunities for each college, we also recognise that with privilege comes great responsibility. This is not a new concept to the AGPT community, of which the colleges, RTOs, GPRA and GPSA are members.
As RACGP President Dr Bastian Seidel presented at GP 17: “there is no virtue in “. As such GPSA will continue to advocate for industry solutions: Watch this space.
Rural Health Commissioner Paul Worley announced
The GPSA Board welcomed the announcement of Professor Paul Worley as the Rural Health Commissioner on Saturday 22 October 2017.
The establishment of the rural health commission and Professor Worley’s appointment to the rural health commission in Australia is a pragmatic step in the right direction recognising the unique environments and scope of practice rural family practitioners deliver care within.
Professor Worley’s experience and therefore understanding and credibility as a rural GP and academic will assist with what is a challenging role.
If the solutions for rural Australia were simple, we would have no need for a rural health commissioner.
GP Supervisors Australia have had a number of opportunities to meet with Professor Worley over the past couple of weeks advocating for the role that GP Supervisors and the Australian GP Training program plays in recruiting and retaining GPs to our rural communities.
The number of GP registrars engaged through the AGPT system has doubled from 2011 to present, yet we still have the same GP distribution issues that have always existed.
It is time for a new approach. There has never been this level of investment in independent medicopolitical structure to help push reforms that are need on the ground. We look forward to working with Rural Health Commissioner Worley to effect positive and lasting benefits to our rural communities.
GPSA gearing up for 2018 NTCER Negotiations
2018 represents a negotiation year for the NTCER (National Terms and Conditions for the Employment of Registrars) and in this regard GPSA have begun to assemble its negotiation team.
In early 2018 GPSA will be seeking the views of GP supervisors about the changes that need to be made to the NTCER in this negotiation.
GPSA staff deal with registrar and training practice challenges with employment contracts on a daily basis so we have a pretty good idea of what the hot spots to be addressed are.
We hope that you will contribute your thoughts about what works well and what you would like to see changed when we seek your views.
Dr Steve Holmes
GP Supervisor Marita Long is returning the inspiring mentorship she received as a mature-aged registrar.
Marita Long, then aged 36, was breastfeeding her third child when she had a vocational epiphany: to study medicine and become a GP.
She fellowed 12 years later, when her children were aged 3, 11 and 15.
The daughter of a tirelessly-working doctor, a young Marita had determined not to follow in his footsteps. Until her life-changing realisation as a mother, she had forged her career as a nurse, predominantly in paediatrics.
“We’d moved from Melbourne to Tasmania; they were crying out for doctors in regional areas, so it seemed like a natural progression,” Marita said of her career change.
In five years as a doctor, Marita, now aged 52, is leaving an indelible mark on the profession as a health carer, and educator of new and existing doctors.
Her teaching journey with General Practice Training Tasmania last year evolved to also becoming a GP supervisor at Sorell Family Practice, one of the three Tasmanian clinics where Marita practises medicine.
Marita has a special interest in women’s health and dementia education, teaching the complexities of dementia at workshops facilitated by GPTT and Wicking Dementia Research and Education Centre, in collaboration with Dementia Training Australia.
She is also helping to develop dementia teaching plans for General Practice Supervisors Australia, which will cover teaching strategies on identification, diagnosis, management, end-of life, and caring for the carer.
“Because we are an ageing population, there will be a significant rise in dementia,” Marita said.
“So, we have to get ourselves skilled up to manage it. We have to take some ownership.
“If we don’t make a timely diagnosis, that has a very negative impact on the patient; and they can’t have an input into patient-centred care.”
Early diagnosis also gave an opportunity to prescribe medication that might help improve the patient’s function, Marita added.
She said supervisors and registrars who had attended the dementia workshops had reported feeling more confident about diagnosis and management of the condition, and hoped the teaching plans would also have a significant impact on GP education.
“It’s hard stuff for a registrar to learn when they have come out of the hospital system, which is focused on fixing things – to working with dementia patients and their families,” Marita said.
Fun Friday a chance to talk ethics
Marita conceded she was not a natural teacher – so, discovering GPSA and its teaching resources was akin to finding a pot of gold.
“Before I became a supervisor, I didn’t know GPSA existed!” Marita said. “Having discovered the GPSA teaching plans has given me a format for lessons.”
Marita said giving her registrars the pre-reading provided in the teaching plans ensured “a really productive, engaging teaching session; something really tangible”.
Another teaching gem for Marita and her medical practice peers has been the GPSA communication flashcards – available in Dr Talk (clinical) and Shades of Grey (ethical dilemmas).
This has sparked a fun, informal teaching session for supervisors, registrars, medical students – and any other practice staff in the clinic’s tearoom – on “Fun Friday” also dubbed “Hamburger Friday”.
“While having hamburgers for lunch, we have an ethical dilemma discussion (inspired by a Shades of Grey flashcard).
“It allows us to have a bit of fun, something to talk about – and a teaching session,” Marita said.
Not only does Fun Friday spark discussion about ethical dilemmas and professionalism in an informal, non-stressful setting, it is an opportune way to engage non-supervisors in informal teaching, and hopefully, a spin-off benefit of inspiring their own GP supervisor journey.
Circle of supervision
Having started her own GP and supervision journey in mid-life, Marita is passionate about paying forward the great mentorship she received as a registrar at Sorell Family Practice.
Meanwhile, she is delighted GP supervisors are continuing the same circle of quality mentorship to her daughter Ella Robinson, a first-year GP registrar in Brisbane.
While it is yet to be seen if Ella will someday also take the leap into supervision, Marita said any GP interested in becoming a supervisor would be well-equipped to enjoy the role with GPSA support and resources.
“Supervision adds variety to my day. If you can teach a registrar, you can teach the patient, and that’s a fundamental skill.”
This month we will be unashamedly self-promotional and mention three important projects that GPSA are involved in with the aim of raising the profile of GP Supervisors in the media, grey and hard literature.
In our National GP Supervisor Satisfaction Survey, recognition of GP Supervisors was one of your top three issues that you want GPSA to advocate about. And one in four of you nominated raising the profile of GP Supervisors through published research as one way of doing that.
So here you go!
Partners: GPTT and Monash University
The SRM project aimed to adapt and validate an instrument that was originally developed for use in clinical psychology in the UK.
A group of experienced GP Supervisors from GPTT then reviewed and adapted the survey for use in general practice and the AGPT program.
A different group of GP Supervisors then piloted the instrument, gave it the green light and we launched it on all of you – our wonderful GP Supervisor members.
Aiming for a response of 300 we were grateful and delighted when 365 of you responded – thank you all!
Results were then analysed by the team at Monash University and whilst we found no differences between urban and rural; age, gender of supervisor or registrar; and a range of other demographic variables; what did emerge was an extremely reliable, valid and robust survey that can be used in general practice to capture YOUR view on your supervisory relationship with your registrar.
Our expert supervisors also thought the survey might have potential for your CPD planning, for detecting GP supervisors at risk of burn-out and for reflection.
Here’s what some respondents said about the survey:
“It is good to reflect on the negative responses I have given and look at what I can work on”
“Interesting reflection, does make you think..”
“I find having registrars encourages me to continue my educational pathway. They can often bring alternative, innovative and current clinical practices to my workplace”
Our focus is now turned on whether we can reduce the survey down from its current 50 items, because we know a survey that size would be impractical not to mention extremely unpopular (it takes about 10 mins to complete).
We also think that this work might be a world first! So we are looking to publish hopefully before the end of the year.
Watch this space!
Partners: GPEx, GPTT and Monash University
The SSRQ is an instrument developed for clinical psychology trainees in the UK to capture the trainee perspective on the supervisory relationship.
Some of the same authors that developed the SRM developed this instrument so we thought it was worth a look to see if it too could be adapted for the general practice sector and the AGPT Program.
This instrument was already reduced from 67 to 18 items and we will be taking the same approach and adapting it for general practice and running the main survey next year.
Watch this space!
Partners: GPTT and Monash University
This project tries to capture and understand the reasons why some people go into GP supervision and others don’t and what their demographic characteristics are.
In conjunction with partners GPTT and Monash University, we hope that the results will be useful for encouraging and enticing more GPs into supervision and to help rural workforce agencies understand how to attract more supervisors.
Watch this space!
As ‘conference season’ comes to a close, there were two items of policy news that have the sector buzzing!
The announcement of Australia’s first National Rural Health Commissioner came at the RMA17 conference.
Emertius Professor Paul Worley was a popular and well-received choice as the man to take up this new and challenging role.
Emeritus Professor Worley currently runs a rural practice in South Australia. He was, until the recent shake-up at Flinders University, Dean of Medicine for 10 years. Professor Worley is
also currently Executive Director Medical Services with Country Health SA Local Health Network.
New GPSA Board member, Dr Frank Maldari, wasted no time in being among the first to congratulate Emeritus Professor Worley along with fellow South Australian and GPSA Board Chair, Dr Steve Holmes and RDAA President Dr Ewan McPhee.
South Australia is becoming quite a hub in the general practice sector!
GPSA congratulates Professor Worley and looks forward to working with him over the coming years. Among his first challenges will be establishing the National Rural Generalist Pathway.
The second bit of policy news came as a bombshell to many in the audience at GP17.
The Hon Greg Hunt, Minister for Health announced the return of GP training to the colleges.
The announcement caught many stakeholders by surprise but the overwhelming response has been positive.
Of course, a lot of uncertainty remains but here’s what we do know: ‘General practice training is back with the RACGP, where it should always have been,’ he said during his keynote address.
A transitional period will commence from January 2019 – December 2021 before the RACGP and Australian College of Rural and Remote Medicine (ACRRM) resume delivery of training, encompassing the Australian General Practice Training (AGPT), from January 2022.
There endeth the certainty!
There will be a lot more detail to come but it is the biggest news in GP training since, well, since the last one in the 2014 budget when 17 RTPs were reduced to 9 RTOs.
It also takes training (or at least the funding of it) back to the colleges from whence it was removed back in 2001 with the formation of GPET.
Back to the future! Except that in the intervening years, we have seen the establishment of Regional Training Organisations.
So the funding for training goes back to the colleges – it remains to be seen how each college will deliver its training – directly or through the RTOs.
It is understood that the RACGP has given assurances that training delivery through RTOs is central to its model.
Watch this space!
Rural Experienced Entry to Fellowship with the Australian College of Rural and Remote Medicine
Are you an experienced doctor who has been working in a rural and remote community for seven years or more?
The Australian College of Rural and Remote Medicine (ACRRM) recognise existing skills and experience through the Rural Experience Entry Fellowship (REEF) program to provide an accelerated option to achieve a Fellowship of ACRRM (FACRRM).
If you have significant experience in rural and remote communities and a specialist registration as a general practitioner in Australia (FRACGP) and vocational registration, you may be eligible to apply for the REEF pathway. This pathway allows candidates to complete the program and achieve Fellowship within 12 months.
FACRRM through REEF applies ACRRM curricula and standards. On acceptance into the program you will be required to undertake two assessments, Mini Clinical Examination and Multi Source Feedback.
No other general practice fellowship covers the scope of practice that ACRRM training provides. Achieving FACRRM enables you to expand your skills and knowledge in rural and remote medicine, verifying that you are qualified to practice anywhere – independently and safely.
Recruiters within rural and remote regions of Australia identify FACRRM as a preferred qualification. In Queensland, a FACRRM provides the certification of choice for 97 per cent of rural generalists.
General Practice Training Tasmania (GPTT) in partnership with General Practice Supervisors Australia (GPSA) and Monash University invite you to participate in a study designed to better understand the reasons why general practitioners (GPs) do or don’t supervise GP Registrars in rural areas of Tasmania and why.
This study will be the ﬁrst systematic analysis of GPs participating in registrar supervision and what underpins their decision to participate.
This project will help to understand Tasmania’s current and future GP supervisor workforce training support needs locally and nationally to ensure there are enough GP Supervisors to meet training demand within the AGPT program into the future.
Your insights along with those of fellow supervisors and non-supervisors will be sought to inform a set of findings that GPTT and other RTO’s can use as a blueprint of future incentives and supports to sustain GP supervisor engagement into the future.
We know your time is valuable. Participants will be given a $200 gift card which will be sent to nominated address on completion of a 45 minute interview. All participant data will be de-identified upon collection.
Interviews will take place between December 2017 and 31 March 2018.
More information can be found in the Participant Explanatory Statement here. If you would like to participate in research that could directly benefit you in your role as a GP supervisor please contact Marisa Sampson by email email@example.com or phone 03 5440 9077.
Marisa Sampson, GPSA
firstname.lastname@example.org or 03 5440 9077
This project is supported by funding from the Australian Government under the Australian General Practice Training Program and support from the Royal Australian College of General Practitioners.
Historically ABS statistics show that Australian’s birth more frequently in March and you guessed it Spring, which means statistically speaking your registrar may be following this trend and have their own baby due soon or in about 9 months time.
As a rural GP Obstetrician, I have to balance my GP work and the needs of the pregnant patients I support. It is rewarding assisting patients with the births of their children. It’s understandable that as a profession we seek to support our GP colleagues through this process also.
GPSA are often asked what practices are required to pay registrars when they go on maternity or paternity leave. The answer is practices are not required to pay registrars beyond their usual NTCER entitlements during this exciting and costly time.
There is however the parental leave pay available to GP registrars, which is a direct relationship between the registrar and human services. You can assist your registrar by providing them with information about where they can find more information about the parental leave pay available from the Commonwealth Government, which we have provided for ease in this eNews.
Though it is rare that a registrar would work for one practice longer than a 12 month period. There are instances where this occurs and in these circumstances the parental leave pay may be paid directly to the employer and must then be passed onto the registrar. Under this scenario there is no out of pocket cost for the practice – it is a simple payroll transaction.
If this is likely to affect you and your practice in the next 9 months, have a look – it may save you some time.
The GPSA AGM is fast approaching. If you haven’t already considered working with a truly functional board, here is your opportunity. It is not a paid role, but the experience and collegiality among a truly exceptional board are priceless. Have a think about it.
Also of note is that the AGPT program will go to a second intake having not filled all training positions for 2018.
Take a look at the ethical dilemma cards in this edition and the best practice responses (cheat sheet for supervisors) created by MDA National. You can use these for in practice teaching.
Finally, we observed RUOK day last week. I hope someone asked if you were OK and that if you are not OK that you are able to reach out. Research shows doctors experience distress in the workplace at twice the rate of the national average for all work types. It’s a tough gig. Be kind to yourselves and those around you. We need each other.
Remember the RUOK Checklist:
Dr Steve Holmes