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Hasty and ill-conceived reforms risk huge setback to GP training

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The AMA has warned of a huge setback to general practice training, including the wholesale loss of experienced educators, unless the Federal Government slows the pace of its reforms and entrusts the GP Colleges with oversight and management of education programs.

AMA President Associate Professor Brian Owler has written to Health Minister Peter Dutton expressing concern that Government changes including scrapping General Practice Education and Training (GPET) and absorbing its functions within the Health Department, shutting down the Prevocational General Practice Placements Program (PGPPP) and abolishing existing regional training providers (RTPs) and putting their functions out to tender, risk undoing recent successes in rebuilding GP education.

In the letter, A/Professor Owler said the AMA was not opposed to reforms of GP training arrangements, “however, we think your reforms need to be built on a more solid foundation and implemented in a more reasonable timeframe”.

“All of these changes are happening at the same time as the intake to the GP training program is being significantly increased, and there is too much potential for things to go wrong, and for the quality of GP training to suffer,” he wrote.

These concerns have been compounded by the haste with which the Government wants the changes to be implemented. GPET is to abolished and new RTPs appointed by the beginning of 2015.

The AMA is worried that much hard-won GP training expertise will be lost as a result of the Government’s changes, and has doubts about the capacity of the Health Department to effectively take on the responsibilities expected of it.

A/Professor Owler said the success of the Government’s reforms depended on the Department’s ability to take over from GPET in successfully coordinating GP training – “a role [it] has no demonstrated experience or track record in”.

Not only was the Department being asked to assume responsibility for a completely unfamiliar task, but it was likely to have to do so without the expertise of many of those currently involved in GP training, the AMA President warned.

“We understand that very few Health Workforce Australia staff have accepted offers of employment with the DoH, resulting in a significant loss of expertise and, at the same time, it is also unclear how many GPET staff will come across to the Department,” he wrote.

“These issues, and the Department’s performance in implementing the much smaller Commonwealth Medical Internships initiative, make it difficult for stakeholders to have any confidence in the Department being able to fulfil this role effectively.”

It is not just the capacity of the Department under question.

The Government’s plans also depend on quickly establishing an effective network of providers to replace the RTPs, something that many doubt will be feasible in the very short time frame set by the Minister.

A/Professor Owler told Mr Dutton that the Government’s reforms relied on the goodwill of the existing RTPs in handing over to their replacements, and on their ability to hang onto staff in the interim “despite a very uncertain future”.

“Dismantling the RTP structure before robust arrangements are in place for the governance and management of GP training is also premature,” the AMA President said. “RTPs have established relationships with practices, expertise and local knowledge that cannot be replaced overnight. In recognition of this, the tender…should be delayed by a further 12 months”.

Instead of relying on the Health Department, A/Professor Owler has proposed that the Government give the GP Colleges, the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, assume responsibility for the governance and management of GP training – an idea backed by the peak group of GPs, United General Practice Australia (UGPA).

At a meeting late last month, UGPA declared that, with their expertise, the Colleges were “best placed” in ensuring the nation’s GPs continued to be trained to the highest standards.

A/Professor Owler said such a role for the Colleges would be in keeping with arrangements in other medical specialties.

“The experience of other specialty Colleges shows that they could do this very cost effectively, and with much less bureaucracy than either GPET or the DoH,” he said.

The AMA President warned that the Governmetn ran the risk of delivering a huge setback to the nation’s supply of quality GPs if it botched its reforms.

“The last time GP training was refofrmed by the Government, we saw the loss of infrastructure and people that took many years to rebuild,” he wrote. “Applications for GP training also plummeted. We want to work with the Government to avoid a repeat of this experience.”

Adrian Rollins