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General practice put in jeopardy by training changes

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The Federal Government has been told its move to scrap GP training agencies and programs risks undermining access to quality care and puts the viability of the profession in jeopardy.

In a strong response to the abolition of General Practice Education and Training and the end of the Prevocational General Practice Placements Scheme, the nation’s peak general practice groups, including the AMA, have issued a joint warning that the decision “poses serious risks to general practice training”.

“The plan, including very short implementation time frames, poses a significant risk to the viability of the general practice profession and access to quality care for all Australians,” the groups said in the joint statement.

In its Budget, the Federal Government announced savings from the abolition of GPET and Health Workforce Australia would help fund an extra 300 GP training places, a doubling of the PIP payment for three-hour GP training sessions to $200, $300,000 infrastructure grants for up to 175 general practices and $35 million for the GP Rural Incentive Program.

“These investments will allow more medical graduates to pursue careers in general practice, and more doctors to practice in areas of greater patient need,” Health Minister Peter Dutton told the AMA National Conference.

But United General Practice Australia (UGPA), which includes the AMA, the Royal Australian College of General Practitioners, the Australian General Practice Network, General Practice Registrars Australia, the Rural Doctors Association of Australia and several other groups, said the changes would undermine GP training and called for urgent talks with the Government.

UGPA said they would reduce the appeal of general practice as a career, result in the loss of GP education expertise and deter practices from employing registrars and offering training.

It was particularly concerned about the decision to fold the functions of GPET within the Department of Health.

“The [Department] has no experience in facilitating general practice training,” UGPA said. “The decision to put the general practice training program out to tender risks a decision being made on price, rather than quality and the long-term interests of the patients.”

The group said GP training must be profession-led and apprenticeship-based, and accreditation must remain with specialist medical colleges.

The criticism, combined with widespread discontent over the introduction of a Medicare co-payment, suggests the Government faces a formidable task in soothing medical profession concerns.

Mr Dutton attempted to go part of the way at the AMA National Conference, where he put some flesh on the Government’s plans to abolish Medicare Locals and replace them with Primary Health Networks (PHNs).

The Minister said that from July next year 61 Medicare Locals would be replaced with a smaller, but not-yet specified, number of PHNs.

“Absolutely essential to their future and their success is that they need to engage properly with general practice and have GPs at the centre of the model,” Mr Dutton said.

The Minister said PHNs would “better match” local hospital network boundaries [of which there are 123], and would have well-defined roles.

“They will not be direct providers of services, but will link up services to meet community needs and keep people out of hospital – either in the first instance, if clinically appropriate to do so, or to stop inappropriate admissions,” Mr Dutton said.

The decision draws heavily on the recommendations of the Horvath review of the Medicare Locals system, which found the network established by the previous Labor Government had delivered inconsistent and unsatisfactory outcomes.

The AMA has long expressed dissatisfaction with the Medicare Locals system, and an AMA survey of doctors found that many felt Medicare Locals were of little relevance, provided limited support and, on occasion, operated in competition with existing medical services.

In its submission to the Horvath Review late last year, the AMA recommended reforms that focused on moving to a network of primary health-controlled organisations that were led by, and responsive to, GPs; that focused on supporting GPs in caring for patients, working collaboratively with other health care professionals; were not overburdened by excessive paperwork and policy prescription; were focused on addressing service gaps, not replicating existing services; and were better aligned with Local Hospital Networks, with a strong emphasis on improving the coordination between primary care and hospitals.

Adrian Rollins