The novation of RTO contracts to college leadership that was expected in May 2020 has very sensibly been deferred to 1 January 2022 according to industry sources. This is sensible because there are a number of items that require more time to work through, namely:
While regional training organisations (RTOs) and local Department of Health agencies alike have enthusiastically put their hands up as the single employer, there are a number of conflicts of interest that need to be mitigated and articulated before it becomes “a thing”.
There are questions such as how do you unwind a system that holds all of the leave entitlements of registrars at various stages across up to six years if a RTO no longer exists in four years – a very real proposition given the last six-year history. Single employer models held by RTOs make possibly the most sense if they were not so susceptible to reorganisation. And the question is, do we want to prevent reorganisation lest it actually be needed in the future?
Flick that same conflict of interest lens back onto the local and regional Departments of Health. How will registrars be managed when there is an inevitable shortage in the hospital system and the registrar is meant to be on a general practice rotation, but their employer prioritises the human risk in the rural hospital adjacent to the GP clinic as being higher priority and rightly higher risk? Will the registrar be coerced into doing as directed by their employer rather than doing as required to fulfill their training? And … who will monitor this?
The truth is, there are always conflicts of interest to be navigated, by all of us, all of the time. That they exist is not the issue. The issue is how we manage them.
In many regards the single employer model works for a multitude of reasons, but it’s not without its challenges, and the remedy for these challenges have yet to be disclosed by those championing the cause. Like most things we can do anything but we cannot do everything and most priority hierarchies are born out of financial and human-resourcing realities, which are scarce resources in health – particularly rural and remote general practices.
GPSA will continue to advocate for our members to ensure supervisors and practices are not disadvantaged by a single employer model.
The discrepancy in distribution remains an issue with Victorian newspapers reporting urban centres having 1:900 ratio of GP-to-population, while rural parts of Victoria have 1:7487 GP-to-population ratio. While the rural generalist pathway will go someway to assisting with this maldistribution, one only has to look at the rural generalist pathway in Queensland to see that it certainly filled the rural hospitals with rural generalists. Many remain in the hospital system to this day and will likely never work in a mainstream general practice.
Also on our agenda this month is the AHPRA consultation on supervision, which would see GPs able to be supervised by nurses in extreme cases. GPSA will be putting in a response to the consultation, which closes 17 December. It will be available for viewing on our website. If you have something you would like us to include in this regard please email: firstname.lastname@example.org. We strongly encourage you to also feed in to this consultation directly. You can do so via the AHPRA consultation page.
Finally, we have been engaged in discussions about the More Doctors for Rural Australia Program (MDRAP) over the past month. This is a workforce program that has been given to the rural workforce agencies to administer. It is clear that there is a poor understanding of the difference between category one supervision and funded supervisor in-practice teaching in this space.
As supervisors well know, category one supervision simply means that as an approved supervisor (by AHPRA not a professional college or RTO) doctors requiring category one supervision requires the supervisor to check every patient prior to them leaving the consult to ensure patient safety. The quality assurance of those approved to supervise: specialist registration, 3 years experience and completing a compliance module online stating that you understand and agree to follow the supervision requirements set by AHPRA.
This patient safety check is not teaching and a doctor on category one supervision is unlikely to progress without some formal teaching around critical incidents and some random case analysis of how they are performing. Thankfully funding to enable in-practice teaching is front and centre of this program for Australian and international medical graduates engaged via the MDRAP.
We will continue to advocate for supervisors in this space.
Yours in GP training,
Dr Gerard Connors
Chair – GPSA