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Towards a stronger future for General Practice training in Australia
James Cook University (JCU) is committed to meeting the health and medical workforce needs of the communities whom we serve. Our focus is on regional and remote communities of northern Australia and beyond, including Aboriginal and Torres Strait Islander communities.
General Practitioners (GPs) are a key part of the health workforce that communities in northern, regional and remote Australia require. This includes GPs who provide comprehensive care for their patients in community primary care practice as well as those rural GPs who, in addition, are skilled to provide emergency and hospital care and other services ('Rural Generalists').
Australia's arrangements for General Practice training date back to the establishment of the Australian General Practice Program (AGPT) in 2001 by the Australian Government under the then Minister for Health, the Honourable Michael Wooldridge. This followed a comprehensive Ministerial review of General Practice Training in 1998.
Having now been in operation for 20 years, the Australian General Practice Training program has not been externally reviewed for impact or value. The medical workforce and health system context has obviously changed considerably over that time. We believe that it is time for thoughtful review of the fundamental purpose of the AGPT program and how it might be best configured to meet current and future community needs. Joined-up thinking is particularly important: the AGPT must operate in synergy with health and medical workforce programs.
The Australian Government is currently considering the options for how General Practice training is to be structured beyond 2022. To assist in that regard and at the request of the Minister for Health, the Honourable Greg Hunt, JCU has developed two issues papers to help inform considerations and contribute to policy and program reform.
The first paper ('The diagnosis, Why integrated regional General Practice training is vital for a strong and sustainable Australian health care system') outlines the features of legacy GP training arrangements through AGPT as well as aspects of the program design that align poorly with community needs, particularly in rural Australia. Among the various issues with the legacy AGPT are the ‘Rural Pathway’ conscription mechanism for overseas training doctors and others, the absence of coherent end-to-end training pathways to GP careers (especially rural careers) and the lack of a positive gradient of incentives for rurally-based training.
The second paper ('The prescription: better General Practice training that is aligned to Australian community needs') sets out a framework for considering the options for re-designing the system:
- 'Why': GP training arrangements should be aligned with other reforms to help make comprehensive primary health care the cornerstone of Australia’s future health care system
- 'What': the characteristics of an idealised GP training system from the community, learner and supervisor perspectives; and
- 'How': defining functions, roles and a set of options for the structure of GP training that best align with the ‘why’ and the ‘what’.
We believe that the single most important priority in national medical workforce reform is to build a substantial pipeline of domestic medical graduates who willingly pursue remote and regional careers in general practice (including rural generalist medicine) and regional consultant medical practice. Only then will Australia be able to stop overstocking cities with excess domestic and imported medical labour. This requires an ‘end-to-end’ system design approach - coordinated action across the continuum of medical education and training. JCU’s experience in this regard is an important example of what can be achieved.
We welcome comment and feedback on these ideas. Please contact the Director of GP training at JCU at firstname.lastname@example.org.