The Royal New Zealand College of General Practitioners

By the time this goes to print, the final of the Rugby World Cup will have been played and what an extraordinary few weeks it has been for New Zealand.

The All Black camp has been at pains to emphasise the amount of time and energy that’s gone into preparing for the tournament and what a collective effort it’s been.

After a similarly huge collective effort, although perhaps one that has not captured the Nation in quite the same way as the World Cup, the College, the Medical Council, Health Workforce New Zealand (HWNZ) and our stakeholders have reached the point where we’re ready to start introducing some very positive changes to GP training.

We all know the challenges we face in sustaining an affordable, effective, safe and equitable health system in the face of financial constraints, demographic changes, escalating costs and workforce shortages.

One way to address these issues is to ensure New Zealand continues to be at the forefront of the global trend for network-supported general practice which offers us the ability to provide efficient and effective care to a broad sector of the community.

To do this we need to keep attracting doctors into general practice and this is one of the main drivers behind the changes we’re making to GP training.

The goal is to offer a new model for GP training that is more appealing and which will encourage trainees to complete the training programmes and stay in general practice.

It’s been a long process to get to where we are today, and there’s still work to be done, but it’s time to applaud the efforts made to get to this point.

It’s been a thorough process involving GPs, GP registrars, medical students, GP teachers, College staff and other medical and health professionals.

I want to thank everybody, particularly the GP registrars, for the feedback we’ve received during the design process. We’ve adopted many of the suggested changes and I’m confident we’ve now developed a programme that is fit for the challenges of the future.

Change to an employed model of GP training

The College and HWNZ have endorsed an employed model of GP training, similar to that underway in the Hutt Valley.

Further discussions are needed, but it’s proposed that from November 2012 bursaries will no longer be paid and all GP registrars will be employed by a DHB, or DHB-related entity.

Employment by DHBs will provide national consistency and equivalence in access to the benefits enjoyed by other medical trainees such as ACC and maternity pay. Employment alongside other registrars is expected to support registrar training in advanced competency models and strengthen the links between primary and secondary services.

From 2012, we are also looking at commencing GP vocational training in November each year, aligning it with the training of other medical specialists.

We will do further work on the costs and benefits to teachers and practices of taking on teaching responsibilities. We will be looking closely at this in the coming weeks.

This will include looking at the implications to teaching practices of having DHB funded registrars, and how costs could be fairly shared between the practice and the DHB.

We’re looking at future GP training being co-ordinated via the Regional Training Hubs which will support practice and DHB placements and provide links with other vocational training and CPD activities. The College will be part of the governance of each of the training hubs.

Where to from here

Although we’ve made great progress, there is still unfinished business and more work is needed. The College is developing a revised curriculum that will be submitted for approval to the Medical Council by mid 2012.

It will take into account emerging models of care such as integrated family health centres while addressing the education and training needs of the generalist doctor working in a range of settings.

Developing the curriculum and syllabus will be an iterative process with refinements made along the way as we start implementing it and learning what works and what needs to change.

The existing three-year training period will be retained.

The College will also implement a revised assessment process from 2013 which will include the PRIMEX clinical examination occurring during the second year of training.

We will also be investigating the feasibility of introducing a web-based modular assessment process.

A formal academic component of GP training will be introduced to be completed during GPEP2 with a range of options for how it can be completed.

New training model encourages generalist approach

The new model is aligned with wider work on the development of new models of care, creating greater integration between hospital and community services and encouraging more flexible generalist health care roles.

In future, most GP registrars will be expected to spend a period of time undertaking supervised training in other medical specialities linked to their personal learning needs and interests.

Formal mechanisms will be introduced to allow GPs to develop advanced competencies in a specialist area of their choosing such as mental health and care of the elderly.

The planned changes build on the best aspects of existing general practice training and ensure that the first stage of vocational training continues to be centred in GP settings as well as valuing the community and patient-focused basis of general practice. 

To learn more about the latest work on the concept of medical generalism, which has underpinned my thinking on the changes to training, I recommend the report released this month from the Royal College of General Practitioners and the Health Foundation in the UK.