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RNZCGP Vocational Training Paper Summary

In August 2010 the College released a discussion document detailing the position that “all doctors working in general practice should have completed or be undertaking vocational training”. In his forward to this document, Ron Patterson, Health and Disability Commisioner for the 10 years to 2009, states “New Zealand, while in the forefront of promoting primary care, has lagged behind other countries (notably Australia, the UK, and Canada) by tolerating general registrants working in general practice.” ….”A decade of assessing complaints in general practice has convinced me that requiring vocational registration is an overdue step to improve the quality of primary medical care.”

RNZCGP's Statement on Vocational Training

The majority of doctors working in New Zealand general practice are vocationally registered however the Medical Council of New Zealand (MCNZ) estimates that approximately 820 medical practitioners currently working in general practice are neither vocationally registered GPs nor participating in vocational training.

These doctors have been able to work in general practice if they establish a “collegial relationship” with a vocationally registered GP. The Medical Council has now signalled that the collegial relationship is no longer sufficient to assure competence.

In 2008, MCNZ chair, Prof John Campell stated “General practice is the specialty, the vocational scope of practice, which treats patients with the widest variety of conditions, with the greatest range of severity (from minor to life threatening to terminal), from the earliest presentation until the end, with the most inseparable intertwining of the biomedical and psychosocial, and treats patients of all ages, from neonates to the elderly, over a lifetime. Why, then, in this most demanding of specialties, can a general registrant, with no postgraduate clinical qualification or formal postgraduate training, practise with no more supervision than a vocationally trained GP and without being a participant in an accredited continuing professional development (CPD) programme?

Almost universally, doctors working in general practice are called general practitioners whether they have completed their vocational training or not. This makes it difficult for patients to easily differentiate those doctors who have completed their training from those who haven’t.

Not only patients but also some government agencies are indiscriminate regarding their recognition of doctors working in general practice. For example the Accident Compensation Corporation recognises, and only interacts with, trained medical specialists in all scopes of medicine except general practice. For general practice, they do not distinguish whether the doctor is vocationally trained, and instead pay all ‘GPs’ at a lower rate because they believe the market does not recognise them as specialists.

Other government agencies, for example PHARMAC and Medsafe, do recognise general practice as a medical speciality. They permit access to or funding for some medications only on a prescription from specialists in particular scopes, including general practice.

General practitioners themselves acknowledge the lack of recognition of career progression and see this as a deterrent for those considering a career in general practice.

The RNZCGP Statement on Vocational Training paper provides further detailed argument and evidence that:

  • Vocational training in general practice improves the quality of patient care and increases patient safety.
  • Vocational training is associated with more efficient and economic provision of health care.
  • Lack of vocational training is associated with competence concerns and complaints.