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GP training – into the great unknown

By Dr Danielle McMullen, a GP registrar, Chair AMA NSW DiT Committee, and AMA CDT representative on AMA Council of General Practice.

Last week thousands of hopeful GP registrars, the future of our GP workforce, were asked to apply for the Australian General Practice Training Program.  But, as it stands today, they are applying to an unknown beast. These doctors must surely feel like they are bravely stepping into a dense fog.

In its 2014-15 Budget, the Commonwealth systematically dismantled the program that has trained many of our highly qualified GPs since 2001.

For more than a decade General Practice Education and Training (GPET) coordinated and oversaw general practice training delivered across the country by regional training providers (RTPs).

While controversial at the outset, GPET then flourished in a growing and increasingly complex environment – it allowed registrars a single point of application and entry, with the flexibility to choose a training pathway towards fellowship of the Royal Australian College of General Practitioners (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM).

At the end of 2014, GPET was quietly rolled into the Department of Health, and in December 2015 the current RTPs will cease to exist. The change is worrying enough (after all, doctors can be creatures of habit), but what is most alarming is that nearly 12 months after the Budget announcement of these changes, we are no clearer on the details of what training will look like in 2016.

At time of writing, the new training organisations remain nameless, shapeless, faceless – we understand there will be fewer of them, but we don’t know how many, where they will be or who they will be.

The tender process for new training organisations has not yet begun, much less been completed.

In addition to the significant changes to vocational training, the 2014-15 Budget also scrapped the Prevocational General Practice Placements Program, which was the only avenue for prevocational doctors in their intern or Postgraduate Year Two year to experience the general practice environment. This gaping hole in the general practice workforce pipeline will result in fewer numbers of interested GP trainees, and throw general practice back to an option of last resort.

We run a real risk of setting GP training back 15 years, to before GPET, when GP training was fragmented, less attractive to junior doctors and we were facing a significant shortage of quality GPs, especially in rural and remote Australia.

At best, we will suffer one or two years of chaos. At worst, the flow on effects of this upheaval will be felt for years to come.

Excellent clinical supervisors, those GPs welcoming registrars into their practices, will forever form the cornerstone of quality general practice training. But they need to be supported by high quality training organisations. And registrars deserve a well-organised, well-supported training environment.

A change is coming – that is for certain. And time is running short but it’s not out yet.

We need urgent clarity and real consultation to plan well and shape the future of general practice training in Australia.

The AMA supports RACGP and ACCRM taking back control of general practice training. The Department of Health should not be the new GPET – the Colleges are best placed to train the specialist GPs of our future. But even they are being kept in the dark.

General practice is an incredible career offering variety, flexibility and fantastic medicine. We need to sing its praises, protect its future, and safeguard its quality. The time for that is now.

Dr McMullen will chair the “General practice training – the future is in our hands” policy session at the AMA National Conference in Brisbane on Saturday 30 May at 2:15pm.

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