The Royal New Zealand College of General Practitioners

 

• GPEP Proposals Frequently Asked Questions (FAQs)

A discussion paper has been circulated on a new model of training that aims to encourage more doctors to choose a general practice career, as well as supporting GPs to work within a changing health sector. The proposals include introducing options for existing GPs and those in training to acquire advanced competencies, requiring some hospital-based practice during GP training and moving towards greater equity between GP registrars and HB-employed registrar terms and conditions.

Extensive discussions with the medical profession, DHBs, education providers and other key stakeholders will take place over the next two months before a final plan is agreed for development and implementation from 2012 onwards.

The key proposals outlined in the discussion paper include:

• providing an enhanced bursary to first year GP registrars that ensures their remuneration is more closely aligned to that of hospital-based first year registrars
• introducing optional enhanced competency modules in areas of practice such as elderly care and mental health care
• changing the nature of assessments to incorporate a more modular approach
• preserving the three year period of training and immersion in general practice in the first year, but with increased time for hospital-based placements.

RNZCGP President Dr Harry Pert said the College believed the proposals would build on the strengths of the existing GP education programme, while introducing new opportunities and support to benefit both current and future GPs and GP registrars.

‘We need to ensure that the education GPs receive offers the right mix of flexibility, skills training and opportunities for personal development.’ Professor Des Gorman, Executive Chair of HWNZ said: ‘We need to ensure GPs are equipped to deal with the challenges of the role and to work in partnership with colleagues in the hospital sector to maintain continuity of care. These proposals will enable GPs to work in a wider range of settings and will create a platform for greater integration between hospital and community services.’

Dr John Adams, Chair of the MCNZ said: ‘The proposals have been developed in response to the increasingly diverse and demanding challenges of general practice, with more services and more complex care provided in the community. We need to continue to modernise our medical education provision to ensure it meets the needs of the profession, patients and the public.’

A website has been set up to provide full details of the GP Training Review proposals. You can register on the website to participate in discussions and provide feedback and comments on the proposals. Click here to read the full proposal document and find out more about having your say.

For more information contact:

RNZCGP: Leigh Parker 021 0278 1909
HWNZ: Maura Thompson 021 025 79 859
MCNZ: George Symmes 027 441 55 88

 GPEP Proposals Frequently Asked Questions (FAQs)

Why are changes to the General Practice Education Programme being proposed?

The key objectives of the proposed changes are to:

• attract more junior doctors to a career in general practice
• develop a training model to meet the changing needs of healthcare delivery
• develop a strengthened generalist medical workforce that can work across a range of settings.

With an aging population, increasing co-morbidity and changes in technology, we need to equip general practitioners to take on increasingly complex roles in the health service. There is little doubt that progressively more complex care will be managed in community settings including integrated family health centres, rural hospitals or linked to Whanau Ora services. We need to ensure that GP training prepares doctors for those increasingly complicated demands.

The overall intention of the proposed changes is to achieve greater integration of training delivered in community and institutional settings and to ensure the future programme has a high degree of flexibility to meet the needs of individual trainees and specific communities.

What information has been gathered so far?

The proposed changes have been developed jointly by the Royal New Zealand College of General Practitioners (RNZCGP), Health Workforce New Zealand (HWNZ) and the Medical Council of New Zealand (MCNZ), following a Memorandum of Understanding signed in May 2010. A steering group of representatives from the three partner organisations has met regularly over the past year to oversee the project, with project management provided by HWNZ.

A discussion document has been published setting out proposals for changes to general practice training, to be phased in from early 2012. Feedback on the document will be gathered between May and July 2011 before consultation with affected parties. Detailed planning for implementation will start in early spring 2011.

How have GPs been involved in the process so far?

During 2010, the project sought the views of registrars, trainers and other key stakeholders on the existing General Practice Education Programme (GPEP).

Advice was provided by a stakeholder reference group made up of current GP registrars; current GP trainers; the New Zealand Medical Association; Te Ohu Rata o Aotearoa (Te ORA); DHB CMOs; the New Zealand Resident Doctor Association; the Rural GP Network; the Division Of Rural Hospital Medicine (RNZCGP); the Association of Salaried Medical Specialists; the College of Primary Care Nurses (New Zealand Nurses Organisation); other medical colleges via the Council of Medical Colleges; the University of Auckland; and the University of Otago.

Feedback received from individuals and organisations has been collated and taken into account in preparing the discussion document.

What models of training have been reviewed to contribute to the proposed changes?

The review process looked at current practice across the sector, both in New Zealand and internationally and emerging models of care. The Rural Hospital Medicine Training Programme and Rural Medical Immersion Programme provided good examples of how the interface between hospital and primary care can be strengthened. These schemes have proved popular with both registrars and students.

What are the differences between the existing training (GPEP) programme and what is being proposed?

GPEP is currently divided into two stages. GPEP1 is a formal training programme structured around two 21 week attachments in general practice (42 weeks in total) and GPEP2 is a less structured two year programme. Registrars must sit an examination (PRIMEX) before entering GPEP2.

The key proposed changes to the GP training programme include:

• treating GPEP 1and GPEP 2 as a more cohesive whole and placing more emphasis on the educational component and supervision/mentoring in GPEP2
• requiring a period of hospital-based practice during GPEP
• offering the option of undertaking an advanced competency module
• introducing a formal academic component
• reviewing the assessment process
• moving towards greater equity between GP and DHB-employed registrar terms and conditions, starting with providing an enhanced bursary.

Some fundamental principles of the current programme would be retained – for example feedback from GPs, trainers and trainees confirmed the value of having the first stage of vocational training based in GP practices.

Will the new training system mean some GPs will be able to work in hospital settings?

The vision underpinning the review is that specialists in a range of vocational scopes, including GPs, may work in both institutional and community settings in the future. In partnership with colleagues from other specialties, it is expected that GPs will assume greater responsibility for providing some care currently delivered in hospital settings, and as well as providing direct clinical care, GPs may increasingly take on the role of consultants leading care
delivered by multi-disciplinary teams. Under the proposals, a requirement to carry out some training in hospital settings/other medical disciplines would be introduced.

Why are advanced competencies being proposed?

Consideration has been given to the range of skills and experience future general practitioners might be expected to provide to their communities, as well as how GPs can have more diverse and challenging career development opportunities. There has been broad support for developing advanced skills and the proposal is to develop modules that will provide those skills within the current scope of general practice.

Modules will be developed in collaboration with other Colleges and will be available to current fellows as well as to registrars. They are not intended to be mandatory. The first module is for Mental Health and Addictions and is being developed in partnership with the Royal Australian and New Zealand College of Psychiatrists. A module on Care of the Elderly is also being scoped in conjunction with the Royal Australasian College of Physicians.

There are a wide range of other advanced competencies that could be developed including management of long-term conditions, sexual health, dermatology, palliative care and rehabilitation medicine. Completing formal training in advanced competency areas may also be used as the basis for enabling GPs to work, with the appropriate clinical governance, in hospital settings.

Will the length of overall training change?

The length of the current training programme has been considered and whether three years is the optimum length of time to prepare general practitioners. Comparable training programmes in other countries were considered and the conclusion was that three years is the appropriate timeframe, given the right mix of educational support and high quality placements. This takes into account the possibility of a set period of time in community settings being defined in post graduate years 1 and 2 (PGY1/2) in the future – something the New Zealand Medical Council has been considering.

How would GP registrars be paid under the new model?

Currently GPEP1 registrars can access a tax-exempt, HWNZ-funded bursary for the 42 weeks of GPEP1. Some are employed by practices or DHBs. GPEP2 registrars are employed by practices, DHBs or are self-employed. It is acknowledged that there are perceived financial disincentives with the current GPEP1 bursary scheme, which doesn’t offer trainees the range of employment benefits such as paid holiday and maternity leave, paid CPD and payment of examination fees enjoyed by other specialist trainees.

There is anecdotal evidence that this perceived disparity may impact on the number of doctors opting to do GP training. The project has looked at the option of employing GPEP1 registrars on the same basis as other registrars. While the medium term objective is to have all vocational trainees employed and remunerated on the same basis, in the short term it is proposed that the existing bursary be enhanced to bring it as close as possible to the conditions of other registrars.

It is proposed the bursary be augmented by:

• setting bursary levels at an after tax equivalent on two specific points on the Resident Doctors Association’s Multi Employer Collective Agreement (MECA) salary scale (basic and experienced)
• matching the MECA increment of 2% applied to other doctors in training in 2010
• establishing a clear policy on parental leave entitlements
• paying examination fees and contributing towards related travel and accommodation costs, and
• establishing access to capped funding to support ongoing professional development.

Will the Primary Membership Examination (PRIMEX) remain the same?

It is proposed that the current assessment process will be phased differently over the three year GPEP.

It is suggested that:

• GPEP will include practice-based assessments of performance in both hospital and general practice settings (mini-CEX).
• The current written examination (PRIMEX) will change to a summative modular assessment using Computer Adaptive Testing (CAT) with the modular assessments being undertaken at any stage of the programme, as appropriate to the registrar.
• The current clinical examination (PRIMEX) will remain essentially the same but may move to the second year of training.
• The final summative assessment will be an examination of performance in the practice context (assessment of consultations) and may also include Multi-Source Feedback (MSF) and case based oral questions.

Will the changes restrict the flexibility of GP registrars to complete their training over a number of years?

Once the proposals have been finalised, part time pathways will be devised. All parties are committed to ensuring that those who are unable to work full time are able to undertake GP training.

Is the Medical Council looking at changing its requirements?

The Medical Council is considering making changes to its requirements for doctors to achieve general registration.

Key aspects of what the Council is consulting on include:

• improving the medical education and training continuum from undergraduate medical education through the intern year to full general registration
• introducing a revised curriculum for interns that focuses on clinical care, communication and professionalism
• changing the requirements for interns to include general medicine, general surgery, emergency medicine and general practice as a minimum
• changing the duration of the intern attachments from the current three months to four months.

Ref: 'Prevocational Training Requirements for Doctors in New Zealand: a discussion paper on options for an enhanced training framework' May 2011.

What are the likely costs of the proposed changes?

There will be financial implications for both establishing and operating the revised programme. Full costing of the new programme depends on the specifics of what will be designed and implemented.

Some of the anticipated drivers will include:

• development of new curricula, administration, monitoring and QA systems
• accreditation of additional training practices, hospital attachments and trainers
• additional costs of the enhanced bursary
• training and ongoing support for trainers
• funding any new academic requirements
• funding the various employment implications:
  • more DHB-employed PGY2s being seconded to GP runs, and
  • salaries and associated employment costs for 8 months GPEP2 training in DHB settings.

When will the new programme start?

Detailed design, confirmation of funding and establishment of a new GPEP is expected to be phased in from 2012, with full implementation likely in 2013.

How will the transition be managed for those currently in GP training?

Any changes to GPEP will apply to new registrars as they join the programme. A transition process will be developed, in consultation with existing registrars, to ensure that they are not disadvantaged and can get the greatest benefit from any changes.

How will you know if the changes have been successful?

As any changes are implemented the College, the Council and HWNZ will continue working in partnership to monitor the effectiveness of GPEP in meeting the emergent needs of the sector.

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