Chair’s Report September 2021

Nicole Higgins
GPSA Chair, Dr Nicole Higgins

Are we willing to be taken for granted ?

In our negotiations with RACGP, ACRRM and the Department of Health, the basic principle of GPSA  has been that;

  • No supervisor should be worse off under the new system 
  • No practice should be worse off under the new system
  • No registrar should be worse off under the new system
  • Supervisors should have equal pay for equal work
  • Supervisor payments should be lifted to the highest rate of the currently applied payments ($150ph) for in-practice teaching 

Supervisor payments have barely increased in the last 20 years and supervision comes at a cost to both the supervisor and the practice. Practice payments are only a part subsidy, haven’t kept up with inflation nor reflect the true cost of hosting a registrar in the practice.

Supervisors want equal pay for equal work. 

A nationally consistent model should pay all supervisors and practices the same. We have recommended loadings for rurality and complexity. 

What concerns me is that;

  1. Supervisors and training practices could be worse off. We could be the “losers” in the transition to Profession Led Training. We have heard that some supervisors could be paid substantially less at a figure of $120 p/h.

    For example this is a $30 p/h drop for South Australian supervisors. This is not acceptable. 

  2. Nothing about us without us. Supervisors were invited to contribute to initial discussions but the decision about how much and for what, will be decided on by DoH and the colleges.

So, what is the trade off for reduced value and less pay?  – workforce

This lever is being used because it is thought that training practices and supervisors will take less money in exchange for having a registrar at a time of workforce shortage. With the supply of overseas trained doctors reduced and a maldistribution of registrars, many practices in regional and rural areas depend on registrars to ensure that their community has continued access to a GP and for business continuity.

Click this link for GPSA’s submission to the Department of Health. 

So, will you continue to supervise registrars if you are not valued and paid less?

I value your thoughts about your future as a supervisor. I can be emailed at chair@gpsa.org.au

Yours in training,

Dr Nicole Higgins

Chair’s Report April 2021

 

Like you all, my practice has welcomed a new cohort of registrars and medical students and celebrated registrars achieving fellowship. This is happening at a time when we grapple with the logistics of covid vaccination, future funding models of general practice, GP shortages in rural and regional areas and remuneration of supervisors and registrars.

Profession-Led Community Based Training
There is a reform agenda being reviewed by the government at present and GPSA is advocating for supervisors and training practices. Our guiding principles:

  1. A GP education system based on an apprenticeship model
  2. Reforms need to be evidenced based and demonstrate that they will improve the GP training experience
  3. All GP’s in training must be supervised
  4. GP supervisors are recognised, supported and adequately funded to provide in-practice clinical supervision and education
  5. GPSA to continued to be funded independently

The recent GPSA supervisor survey demonstrated a high degree of trust in the RTO’s by supervisors. GPSA is concerned about the impact on supervisors, training practices and registrars with the cessation of RTO contracts in February 2023. It has taken a long time to rebuild relationships and capacity in GP training after the previous shakeup in 2015. GPSA will work hard to ensure the integrity of GP training into the future on behalf of our members.

We seem to be chasing our tails and starting at the wrong end. The whole GP training journey starts from entry to medical school and then exposure to general practice as an undergraduate. Many of our supervisors train medical students as well as registrars and know the importance of exposure to general practice in those formative years.

Why is the review called for? The answer is workforce. How do we get the doctors with the right skills in right places. It isn’t as easy as it sounds. Simple solutions can have big unintended consequences at the other end of the pipeline.

And it is complicated… There are many fingers in the funding pie, many agencies wanting pieces of the pie and the government has said that there will be no increase in funding. Most importantly, we want to keep general practice funding in general practice. Both RACGP and ACRRM are commended for working well together and working with the government to support sensible policy reforms.

GPSA supports initiatives for our rural supervisors, but we have concerns about the impact of the proposed change in definition of ‘rural areas’ as MM3-7 as opposed to MM2-7. Training in outer regional MM2 areas, which service rural communities will be impacted the hardest as they will struggle to attract registrars if they are competing against their urban counterparts.

As we review the system, we need to provide certainty and stability. GPSA will continue to work with our key stakeholders to ensure the best outcome for GP training.

On a different note, GPSA is kicking some big own goals!

Some stats

 

Dr Nicole Higgins
Chair GPSA

 

Exploring the financial costs and revenue associated with teaching and supervision in general practice

 
 
Teaching practices and supervisors are critical in the delivery of general practice training in Australia. However, recent data from the General Practice Supervisors Australia (GPSA) National Survey indicates that 83% of supervisors feel they are not receiving adequate recognition or remuneration for the investment required to train our next generation of GPs. In addition, the 20% of supervisors who indicated that they were planning to retire in the next five years, cited reasons including frustration with the administrative arrangements and poor financial return, particularly those in smaller practices; suggesting that this may impact the sustainability of our supervisors and teaching practices. In order to address the financial viability of supervision, we need to better understand the costs associated with teaching and supervision in general practice.

We are also currently in an environment where there are many upcoming changes to the general practice training landscape, which may impact on the requirements placed on practices.

GPEx and GPSA are proud to be partnering with the University of Adelaide to undertake this important research study in 2021. The aim of this study is to better understand the financial costs and revenue associated with teaching and supervision in general practice. Early in 2021, we will be seeking a representative group of supervisors and practice managers nationally working in private practices to participate in in-depth interviews, this will be followed by an invitation to a broader group of supervisors to complete a survey.  There will also be opportunities to contribute to costing model validation. We encourage you to participate in this project and share your experience.

With supervisor and practice sustainability already being questioned, it is important for funders to consider how a future model for teaching and supervision in general practice can be developed which is financially viable, and acceptable to registrars, supervisors and practices.

Findings from this study can help inform discussions and decision-making regarding the planning of future registrar employment models and practice payment models.

Information on how you can be involved in this research study will be provided via email shortly.

For more information about the project please email michelle.pitot@gpex.com.au

This research project is supported by The Royal Australian College of General Practitioners with funding from the Australian General Practice Training Program: An Australian Government initiative.

Chair’s Report September 2020

Nothing should be decided about us, without us

GPSA …..the expert in the supervision of our next generation of family doctors

If the rumours are true, there is about to be a seismic shift in how we train our next generation of GPs.

If the rumours are true, the Department of Health has temporarily halted transition of training to the colleges, supervisors and registrars are to be employed by the government and RTO’s are endangered. We have asked the department for clarification and I can only hope that the decision making is being done in a slow and considered way with an understanding of the risks involved. The unintended consequences of these changes could be significant.

As a key stakeholder representing the interests of 5500 supervisors, GPSA is always willing to consult and support change that improves the conditions of supervisors, registrars and our patients, in a way that is meaningful and evidenced-based.

There have been tumultuous times in GP training in the past which resulted in a significant drop in the numbers of GPs in training. The knowledge and skills which are lost in each iteration take years to rebuild.

General practice is struggling to recruit the next generation of family doctors due to a chronic underfunding and undervaluing of the profession. Any further uncertainty or changes could further affect the numbers of doctors wanting to become GP’s.

In 2001, the Australian Government established General Practice Education and Training (GPET). The main role of this new company was to establish the Australian General Practice Training (AGPT) program. This model was to deliver a regionalised model of training, improve vertical integration and encourage innovation. We got there and then it changed again.

In 2016, GP training underwent another major overhaul. We lost GPET and transitioned from RTP’s to RTO’s (Regional Training Providers to Regional Training Organisations) and reduced the number of providers. It is still a matter for contention if GP training is better off because of this rationalisation. Once again, training numbers dropped and the sector had to rebuild. After only 4 years we are looking to change again.

So where do supervisors sit amongst this change?

Supervisors could be paid for teaching directly by the government.

A single employer of registrars may mean less administrative hassle for practices whilst having a registrar not employed by you could change the dynamics of the relationship.

For registrars, having an employer external to their practice may change terms and conditions to be the equivalent of their hospital colleagues whilst reducing choice and flexibility. It provides the government with a lever to allocate registrars to areas of most need which is often not what the registrar would choose. This loss of flexibility and choice may make general practice even less attractive and reduce numbers further.

It is an interesting time to step in as the new chair of GPSA. I have been a supervisor for many years and a medical educator for GP Supervisor support and registrar remediation in the past. I have been able to grow my relatively new practice with the support of doctors that I have previously trained. I understand the many issues which supervisors and training practices have to manage.

As new chair of GPSA, my vision is for GPSA to;

I wish to thank Dr Gerard Conners for his hard work as the previous chair and say goodbye to Dr Steve Holmes (ex- Chair) and Dr Sarah Chalmers (ACRRM President). I welcome the fabulous talent of Dr Madhu Tamilarusun, Dr Justin Coleman and Dr Maria Boulton to the GPSA board.

Supervisors – the cornerstone of GP training.

Dr Nicole Higgins
Chair GPSA

RTO Network Chair Report

How did we go from “seamless transition” to disruption?

GP17 seems so long ago. In his annual address the Federal Health Minister, Greg Hunt, was met with acclamation when he announced the return of general practice training to the profession. For too long both our general practice colleges have been the odd ones out when it came to the Australian Medical Council standards for specialist training. We were assured that 2019-2021 were transition years and that the RACGP and ACRRM would take over their training programs from 2022. That everyone would be supported to ensure that registrars, supervisors, practices and patients would not be affected. That the transition would be seamless.

It is now 2020. There have been delays. We are all dealing with a once in a century international health emergency. Rumours abound that the transition is now on hold. That options are being canvassed and decisions are about to be made very quickly. I don’t get it. General practice is under huge threat. Our country needs roughly 40% of our medical graduates to become GPs. At the moment that number is under 20%. The whole of the profession is behind College-led training.

It has brought the Colleges much closer and they appear unified in their confidence in their ability to lead training programs that meets not only the needs of their registrars, but the needs of their patients. We have a new national Rural Generalist Training Program. Disrupting that transition will place registrars, supervisors and educators under significant stress. In that event, how are we to convince the next generation to undertake general practice training. Not only will be have an uncertain training program, but the ongoing poor funding of general practice itself.

Dr Ian Kamerman is a GP supervisor, a current Chair of GP Synergy and Chair of the RTO Chair’s Group. He is a former Chair of GPSA.

Chairs Report for August

As I write this from Melbourne in Stage 4 lockdown, the nation is sobered by an ever rising death toll and sustained community transmission; it is punctuating the way we live and work as GPs.

Two Doctors are occupying Melbourne ICU beds One a 30+ yo emergency doctor, the other a 60+ yo GP. Another GP, aged in their 30’s has also been infected while working at a drive through testing clinic. We are all at risk on the front line against this virus; which should give pause to us all.

The Victorian and Federal Government’s have asked aged care workers not to work in more than one facility; this same standard in Victoria has been extended in Stage four lockdown restrictions to all settings and we support this move by the Andrews Government to keep everyone safe and ensure that our practices remain open and available to our patients at this critical time.

If you have not yet heard, there is now a requirement in Victoria to complete a COVID safe plan . Every operating business at this time is required to have a completed plan in place by 11.59 on Friday 7 August 2020.

Supervisors have raised concerns with GPSA that registrars are requesting annual leave to work in Covid 19 wards in private hospital, COVID testing sites and then returning to their training practice.

This directive at least in Victoria, at least provides a reasonable basis on which to not allow leave for this purpose and further for Victorian practices to issue an organisation wide policy requiring staff to refrain from working across more than one site. For some this will be logistically difficult, but necessary.

This issue will arise again before we are on top of this virus and it’s important that GPSA works with GPRA, RTOs, the Colleges and State and Federal Governments to develop recommendations and policies for this. To this end we have written o Minister Hunt seeking recommendations proportionate to the outbreak in Victoria specifically.

Initial discussions with my CEO Glen Wallace tell me that a clause can be written into an employee’s contract prohibiting work for another employer outside the practice. As few or no practices would have thought of this, we will have to rely on the goodwill of registrars and mutual agreements between registrar and practices to protect all those working in our General Practices.

Of critical importance at this time is ensuring that practices remain open to our patients.

This is my last report as Chair. The GPTA AGM is being held on 2/9. Dr Steve Holmes will be retiring from the Board at that meeting. A past Chair of GPSA and a passionate advocate for rural practice, Steve will be sadly missed from the Board. Well known for his wicked sense of humour, Steve’s insights and wise counsel (often delivered to me in late night phone calls) will also be sadly missed.

There are 2 elected positions available on our hard working, voluntary Board. I shall be standing again and I encourage any Supervisor who has an interest in Governance and Education to stand.

I would like to thank the Board for their excellent work over the past year.

GPSA recently submitted our report to the Department of Health, which gave me cause to reflect on how much our hard-working GPSA team, ably led by our CEO Glen Wallace achieves with a modest (but much appreciated) grant from the Federal Government.

There is a lot to be proud of. And we know that you agree, because not only has GPSA been able to maintain its membership, but membership growth sat above 10% this year – driven by the webinars and resources that we were able to commission as a result of the funding we gratefully receive from the Australian Government under the Australian General Practice Training Program.

Finally, a big thanks to all the GP Supervisors around Australia who are training the next generation of GPs.

Gerard Connors
Chair GPSA